Table 3 Summary of themes, sub-themes, and representative quotes

Several sources contribute to a widely inconsistent understanding of the impact and management of alcohol consumption

Disparity in quality of clinical advice (9/14)

Alternative sources of information (8/14)

Personal experience as a learning tool (7/14)

Understanding of the impact of alcohol (14/14)

1. “My diabetes team… said to me, make sure you test, make sure you eat, make sure you have your kit on you – you pretty much never leave home without it. Stick to one thing, don’t change drinks during the middle of the night because that’s what’s gonna hit you harder” (Participant 5)

2. “I got given… a big kind of folder-ish pamphlet thing. But they never really explained things to me, I’ve kind of had to figure it out all myself throughout these years” (Participant 6)

3. “I have been to diabetic camp when I was a teen, and we did have a little bit of an information night about how when you first start drinking, do it in a safe environment so you know what your blood sugars are going to do before you go out to town” (Participant 10)

4. “I guess I’m kind of used to it [learning through personal experiences] with diabetes anyway, like, trying to sort things out for myself. So, it was just, yeah, kind of just a learning curve [learning how to drink with diabetes] … I don’t mind trying to kind of figure things out, because then I know where I’m at, rather than you [medical professionals] like telling me what to do” (Participant 6)

5. “I find that alcohol and drinking actually spikes my blood sugars – even without having sugar in it. So, it spikes my blood sugars and then I come crashing down afterwards” (Participant 9)

Inconvenience of maintaining healthy glycaemic control whilst drinking socially

Reduced frequency of monitoring (8/14)

Intoxication impacting the ability to give insulin (4/14)

Omittance of insulin (3/14)

Removal of insulin pump (2/14)

6. “If I did a blood test [whilst drinking], I probably wouldn’t act on it. So, there’s no point in doing it. And then it’s also the need to take and look after my blood test kit… taking it into a club or anything is just asking for it to be stolen” (Participant 3)

7. “But usually that’s [overdosing insulin] just because of poor judgment [due to alcohol] and that sort of thing on my behalf. I look at my blood, it’s high. Okay. I take stuff [insulin] to go down, I check a bit later, it’s not gone down. And I get mad, and I just over correct [with more insulin]. And then it suddenly goes through the floor” (Participant 2)

8. “I don’t know it’s just admin [having to inject insulin]. If I have a low when I’m out, if it’s like in town, that’s when I can pop to a Night ‘n Day [convenience store] or something. But at a party I have to ask someone for food which is just kind of embarrassing” (Participant 7)

9. “Some nights, if I’m wearing something that doesn’t allow me to wear my pump as easily, I’ll just take it off… I’ve gone high and forgotten to put it back in” (Participant 12)

Engagement in initiative-taking strategies for harm reduction occurred when convenient

Changes to food intake (13/14)

Modification of insulin dosage (9/14)

Preference for low carbohydrate drinks (11/14)

Peer involvement in diabetes care (14/14)

10. “So they [other young adults] always say ‘eating is cheating’. But I always make sure that I eat beforehand have a decent meal at dinner, or before I go out anywhere [to drink]” (Participant 5)

11. “I will make sure I have like a really carb-heavy meal [before drinking] and then not do insulin for it, just so my blood sugar is quite high and can handle whatever is gonna happen” (Participant 3)

12.“People bring, like, RTDs (ready-to-drinks) …I tend to avoid them because I know what they’re like is pretty much just lemonade and vodka, and that sort of stuff you know, that will just shoot my carbs up” (Participant 2)

13. “I inform everyone that needs to know that I have diabetes… So, if something did go wrong, they can call an ambulance straightaway… They just know to give me sugar [If I’m low], and if I’m high they know I’ve got to inject myself with insulin” (Participant 1)

Impact of modern diabetes technology in overcoming previous burdens and promoting glycaemic safety

Increased satisfaction compared to SMBG (8/14)

Additional benefits of systems (3/14)

14. “The sensor has been amazing… it’s just so much easier, and especially with going out and stuff. It’s just anyone can do it for me if I really needed them to. Whereas [with capillary blood glucose] testing, it’s a bit harder. It’s not available when you need it. It’s just more of a hassle, you know, having to get it out” (Participant 6)

15. “It’s so good because I don’t need to do anything. I can just look down at my pump [paired with a CGM sensor] and I’ve got my reading. Yeah, definitely takes off a lot of like the stress of having to remember” (Participant 12)

16. “I found with the pump [paired with a CGM sensor] it would tell me where my level was it, where it was heading, and what my levels had been like in the past” (Participant 8)

17. “In terms of the CGM, I was doing the closed loop [automated insulin delivery system]. So, it would give me insulin if I was going high, and it would stop my basal or any insulin delivery if it was thinking I was going low… With alcohol, I guess it did help prevent those rapid crashes that sometimes I would experience. I would gradually stable out, rather than dropping really quick” (Participant 10)