A gentleman has a history of diabetes mellitus. He developed symptoms of unconsciousness after a drinking session and was diagnosed with hypoglycemia when he went to the hospital and was tested with an immediate blood glucose of 2.0 mmol/L. Is the hypoglycemia that occurred in this gentleman related to his alcohol consumption? Why does alcohol consumption cause hypoglycemia? Let’s start with the metabolism of alcohol. Alcohol is mainly metabolized in the liver, and the process of metabolism is that ethanol is converted to acetaldehyde in the liver cell plasma by the action of ethanol dehydrogenase, and acetaldehyde is metabolized to acetic acid by the action of acetaldehyde dehydrogenase, and finally to carbon dioxide and water. During the conversion of ethanol to acetic acid, coenzyme I is reduced to reduced coenzyme II (NADH), and the NADH/NAD ratio increases, inhibiting the conversion of lactic acid to pyruvic acid and thus preventing gluconeogenesis. When hepatic glycogen stores are not abundant due to malnutrition such as starvation, alcohol inhibits or attenuates the release of gluconeogenic hormones (adrenocorticotropic hormone, glucagon and growth hormone) during hypoglycemia by suppressing hepatic gluconeogenesis (gluconeogenesis is the main source of plasma glucose in the fasting state of the human body) in the event of depleted hepatic glucose, which aggravates the onset and prolongs the recovery time of hypoglycemia. The hypoglycemic syndrome caused by alcohol (ethanol) intoxication is called alcoholic hypoglycemia. One is postprandial alcoholic hypoglycemia, which occurs 3-4 hours after drinking and is due to stimulation of insulin secretion; the other is fasting hypoglycemia that occurs after heavy drinking without food and after depletion of stored hepatic glycogen, which occurs about 8-12 hours after drinking and fasting. In diabetic patients, drinking large amounts of alcohol, especially on an empty stomach, can inhibit the gluconeogenic response, resulting in severe hypoglycemia. Patients with diabetes, especially those on sulfonylureas and those who inject medium- and long-acting insulin at night, should avoid drinking large amounts of alcohol on an empty stomach. Hypoglycemia, once diagnosed, should be treated immediately in order to return the blood glucose concentration to normal as soon as possible. 1.Immediately give 50% dextrose 50～150ml intravenous push; also can intravenous drip 5% dextrose. 2.In combination with acute alcoholism, naloxone can be added. 3, such as glucose can not be given after rapid recovery, should be added with hydrocortisone intravenous infusion; and give neurotrophic drugs to prevent cerebral edema and intracranial hypertension. Most patients with hypoglycemia can recover rapidly after treatment without permanent sequelae, but if due to late medical treatment or delayed diagnosis, a few patients will be left with different degrees of neurological impairment or even death due to prolonged hypoglycemia leading to cerebral edema and central nervous system damage. Alcohol consumption should be moderate and prevention is the key. It is best not to drink alcohol, and diabetic patients with poor liver function should not drink alcohol. Diabetic patients drinking four know: 1, choose low-alcohol, low-sugar wine; because of the high alcohol content of spirits long-term drinking easy to merge with fatty liver, alcoholic cirrhosis of the liver, the central nervous system reaction abnormalities. 2, appropriate control of alcohol consumption, the amount of alcohol intake should not exceed 30 grams a day, no more than 3 times a week. 3, avoid drinking on an empty stomach, especially when drinking at dinner, you must eat the main food. 4.If you drink alcohol at dinner, measure your blood sugar before going to bed, if your blood sugar is lower than 4.0mmol/L, make sure to have additional meals, such as bread, steamed buns, cookies, etc., to prevent nighttime hypoglycemia.