Harm Reduction: Drugs and diabetes

Type 1 Diabetes Mellitus

In this article we will focus on Type 1 Diabetes Mellitus, the most common type of diabetes mellitus in youth and young adults. 2021, It is estimated that there were about 8. 4million individuals worldwide with type 1 diabetes: of these 1·5 million (18%) were younger than 20 years, 5·4 million (64%) were aged 20–59 years, and 1·6 million (19%) were aged 60 years or older.

Type 1 diabetes mellitus, also known as juvenile diabetes, is a chronic autoimmune disease that occurs when the body's immune system mistakenly attacks and destroys the insulin-producing cells of the pancreas. This causes a lack of insulin production and can lead to high blood glucose (sugar) levels.

Some common symptoms of Type 1 diabetes include:
• Increased thirst and frequent urination
• Increased hunger
• Fatigue and weakness
• Blurred vision
• Unintentional weight loss
• Irritability or mood swings
• Slow healing sores or frequent infections

Treatment for type 1 diabetes usually involves insulin injections or an insulin pump. It is important for people with type 1 diabetes to regularly monitor their blood glucose levels and adjust their insulin dose as needed.

In addition, people with type 1 diabetes should follow a healthy eating plan, engage in regular physical activity and monitor blood pressure and cholesterol levels to reduce the risk of developing complications such as cardiovascular disease, nerve damage and kidney damage.

Diabetes Mellitus and drugs

DM1 affects mostly young people. This segment of the population has the highest frequencies of recreational drug use.

Young people with DM1 have the same motivations and concerns as those without the disease. It is clear that not using drugs is the best way to avoid problems. But it is also clear that a significant proportion of them will use them. Indeed, there are studies that indicate this: https://pubmed.ncbi.nlm.nih.gov/15008844/ https://pubmed.ncbi.nlm.nih.gov/22356493/ There are specific risk reduction measures for people with diabetes who use drugs.

General measures

• In the first months after diagnosis, disease management is often particularly complicated. Some training is necessary to learn to manage the timing of blood sugar measurements, recognise hypoglycaemia or hyperglycaemia, measure insulin doses, calculate the meal before or after exercise ..... All this becomes simpler over time. Before considering the use of any drug, it is important to know how to manage diabetes.
• Monitor blood glucose levels frequently: It is important for individuals with Type 1 Diabetes who use recreational drugs to monitor their blood glucose levels frequently, both during drug use and in the hours following use. This can help them identify and treat hypoglycemia or hyperglycemia (high blood glucose levels) as quickly as possible
• Carry fast-acting sources of glucose: Individuals with Type 1 Diabetes who use recreational drugs should carry fast-acting sources of glucose with them at all times, such as glucose tablets, candy, or juice. These can be used to quickly treat hypoglycemia.
• Stay hydrated: Some recreational drugs can cause dehydration, which can exacerbate the symptoms of hyperglycemia. Individuals with Type 1 Diabetes who use recreational drugs should drink plenty of water and avoid alcohol, which can also cause dehydration.
• Never take drugs alone. Make sure that someone with you knows your situation, knows how to measure your blood sugar and inject the right amount of insulin or fast-acting sources of glucose.

Specific substances

Alcohol

Alcohol consumption can have an impact on blood glucose levels, which can be particularly concerning for individuals with Type 1 diabetes who rely on insulin therapy to manage their blood glucose levels. However, in moderation, alcohol can be safely consumed by many individuals with diabetes.

When it comes to choosing which alcoholic beverages to consume, it's important to consider the carbohydrate and sugar content of the drink. Drinks that are high in carbohydrates and sugar can cause a rapid increase in blood glucose levels, which can be particularly problematic for individuals with diabetes.

Here are some examples of alcoholic beverages that are generally considered to be less harmful for individuals with Type 1 diabetes:
• Light beer: Light beer contains fewer carbohydrates and calories than regular beer, which makes it a better choice for individuals with diabetes.
• Red or white wine: Red or white wine can be a good option as they typically contain fewer carbohydrates than beer and some mixed drinks.
• Spirits: Spirits such as vodka, gin, or whiskey are lower in carbohydrates than beer or wine, and can be mixed with sugar-free mixers such as diet soda or Coke Zero.

On the other hand, there are other drinks particularlly risky:
• Regular beer: Regular beer typically contains a higher amount of carbohydrates than other alcoholic beverages, which can cause a rapid increase in blood glucose levels. may pack 35–44 grams of carbs per 7-ounce (225-mL) serving
• Sweet wines: Sweet wines such as dessert wines, port wines, and some sparkling wines contain higher amounts of sugar and carbohydrates than other wines, which can cause a rapid increase in blood glucose levels.
• Mixed drinks: Mixed drinks, such as margaritas, daiquiris, and other cocktails, may pack 35–44 grams of carbs per 7-ounce (225-mL) serving. The same goes for cream liqueurs such as Bailey’s and Kahlua. These provide around 13 grams of carbs, of which 12 grams are from sugar, for every 2 ounces (60 grams) of beverage.

Tobacco

Smoking tobacco is a major risk factor for cardiovascular disease, and individuals with diabetes are already at an increased risk of developing this condition. Smoking can further increase the risk of cardiovascular disease in individuals with diabetes, potentially leading to heart attacks, stroke, and other complications.

Tobacco can enhance insulin resistance and reduce the effectiveness of diabetes medications.

Smoking can impair wound healing, which can be particularly problematic for individuals with diabetes who are already at an increased risk of developing foot ulcers and other wounds.

Cannabis:

The consequences of cannabis use in diabetic patients are not very clear. Some studies suggest that the risks are similar to those of tobacco although they are probably biased by the fact that many of the participants also smoke tobacco.

On the other hand, it has been suggested that some cannabinoids may have a beneficial effect on blood glucose control, although there are also not enough good studies.

It is important to remember that cannabis increases appetite, which may have consequences in DM1.

The use of vaporisers instead of combustion (with or without tobacco) is also particularly advisable.

Stimulants (cocaine, amphetamine, methamphetamine)

There is no direct effect between stimulant use and blood sugar levels. But it is important to be aware of what you are doing while using them. Intense physical exercise (sex, dancing) can have an impact on carbohydrate expenditure and facilitate hypoglycaemia.It's important to take regular breaks and rest to avoid exhaustion, which can affect blood glucose levels.

On the other hand, it is important to consider that stimulants can also reduce appetite. It's important to have healthy snacks available, such as fruit, juices and low-carbohydrate foods, to maintain blood glucose levels.

Psychedelics and psychedelic-like (MDMA)

The previous considerations on stimulants (in terms of exercise and appetite) apply.

In addition, some psychedelics alter the perception of time. It may be important to set an alarm clock to remember to monitor glucose.

Psychedelics, MDMA and ketamine alter the perception of one's own body. In the usual state of consciousness diabetics can recognise a rise or fall in blood sugar by their bodily sensations. These substances can alter these perceptions, making it difficult to recognise them.