Diabetes or DUI?

What is diabetes?
Diabetes occurs when the pancreas does not function normally to release insulin to aid in the ability of the cells to take up the glucose (sugar) it needs for energy. When we eat, the body turns food into glucose. The function of the pancreas is to release enzymes to aid in the digestion of food and to release hormones such as insulin.  In type I diabetes, the pancreas does not produce insulin requiring the individual to supplement insulin. Type II diabetes is when the pancreas can produce its own insulin but does not utilize it effectively. These individuals typically are on oral medication to aid in the control of blood glucose levels.

How does diabetes simulate alcohol intoxication?

When blood glucose levels elevate, individuals experience symptoms such as headache, fatigue, hunger, blurred vision, confusion, trouble thinking or concentrating and nausea. Blood sugar levels that get too high can be life-threatening and can produce ketones. Ketones are chemicals that are produced when the body breaks down fat to use for energy instead of glucose. When the ketones build up, the blood becomes more acidic. This acidity can cause the “fruity breath” odor that can be noted in diabetics that can be mistaken for alcohol.

Alcohol (ethanol) breaks down in the body first by the stomach and, depending on the presence or absence of food in the stomach, then the majority travels into the small intestine where there is a larger surface area for absorption. As alcohol is absorbed into the body, it enters the bloodstream, brain, and liver and is immediately metabolized as it is recognized as a “foreign substance.” Once this metabolism occurs, the ethanol is broken down into acetaldehyde (CH3CHO). Further breakdown occurs and acetaldehyde is broken down into acetic acid (CH3COO) or acetate. A small amount of alcohol does not undergo the metabolic cycle and is released through the respiratory system which is a sweet, fruity smell.

Some type II diabetics will require treatment control with medications called biguanides. The most common biguanide is Metformin also called Glucophage.  Metformin decreases liver glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity. However, Metformin is also linked to a life-threatening condition called lactic acidosis.  Unfortunately, the use of Metformin can lead to elevated levels of lactate.  Symptoms individuals can experience with elevating lactate levels are confusion, fatigue, headache, rapid heart rate, muscle cramping, overall body weakness, and fruity-smelling breath. This odor on the breath of the diabetic can be mistaken for alcohol consumption.