Alcohol may produce hypoglycaemia in several different ways. The most important is by the inhibition of gluconeogenesis, which can result in a profound and particularly dangerous form of fasting hypoglycaemia, especially in children. Another is by increasing the amount of insulin that is secreted in response to an oral carbohydrate load. A special example of this occurs when a sugary drink mixed with alcohol (for example, a gin and tonic) is drunk on an empty stomach (Fig. 20.25). The ingestion of a small amount of predominantly starchy food with an alcoholic drink does not abolish, and may even enhance, this propensity to develop symptomatic reactive hypoglycaemia.
