Diabetes and drugs: harm reduction

I hace Type 1 Diabetes. I am interested in diabetes and drugs: harm reduction strategies, tips…Also, I want to kow which drugs are more and less harmful.

Originally posted in SR 2.0 . Reviewed 20/2/22

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In this post we will focus on Type 1 Diabetes Mellitus (DM1), the most common type of diabetes mellitus in youth and young adults. 2021, It is estimated that there were about 8 million individuals worldwide with type 1 diabetes: of these 1,5 million (18%) are less than 20 years, 5,4 million (64%) are 20–59 years, and 1·6 million (19%) are 60 years or older.

DM1, also known as juvenile diabetes, is a chronic autoimmune disease. This 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 DM1 s 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 DM1 usually involves insulin injections or an insulin pump. It is important for people with DM1 to  monitor blood glucose levels and adjust insulin dose.

In addition, people with DM1 should follow a healthy eating plan, engage in regular physical activity. Also, monitor blood pressure and cholesterol levels. So, they can reduce the risk of cardiovascular, neurological or kidney complications .

1-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:

There are specific risk reduction measures for people with diabetes who use drugs.

2.-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.  To recognise hypoglycaemia or hyperglycaemia can be difficult. Also to measure insulin doses or 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 DM1  to monitor blood glucose levels frequently. This should be don both during drug use and in the hours following use. This can help them identify and treat hypoglycemia or hyperglycemia  as quickly as possible

Carry fast-acting sources of glucose: Individuals with DM1 who use recreational drugs should carry fast-acting sources of glucose with them always. For example,  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. DM1 drug users should drink plenty of water and avoid alcohol, that causes dehydration.

Never take drugs alone. Make sure that someone with you knows your situation. A friend who knows how to measure your blood sugar. And also to inject the right amount of insulin or fast-acting sources of glucose.

3.- 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:

Probably, tobacco is the most harmful drug for a diabetic.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.

E-cigs probably pose less risk than smoked, conventional tobacco.

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.

 

Nasal problems after high cocaine dosage

Nasal problems after high dosage cocaine

A while ago I insufflated about 500 mg cocaine in the coarse of an evening, it was the first time I used coke. So nearing the end of the evening I had an constant runny nose which was pretty annoying. I cleaned my nose with saline, but nevertheless by the time I went to bed my nose was totally clogged up.

The next morning when I blew my nose, all of the mucus was red coloured. For about a week afterwards there I had blood in my mucus, it became less and less till finally no blood at all after a week and the mucus was colourless again.

Clearly this is a sign that my nose didn’t like what I put up there, but I’m not sure how harmfull it is. Is such a reaction ‘normal’ for coke use? Could another coke experiment be conducted without a risk on permanent damage, or is coke a nono for my nose?

Originally posted in SR 2.0 15/10/2013. Reviewed 20/2/22

Intranasal damage is a common problem with drugs used by this route of administration.

Dosage, frequency and technique of use are important factors that influence the frequency, severity and likelihood of problems.

Cocaine itself (and associated impurities) can irritate nasal tissues and cause them to bleed. Cocaine has a vasoconstrictor effect (reduces blood flow to the area).In your case the problem seems to have solved itself spontaneously. But an acute sinusitis (nasal congestion, pressure pain in the face, headache, green and smelly mucus) is a possible complication that should be treated with antibiotics.

Half a gram seems like a fairly high dose for an inexperienced person. If that amount of any substance is administered intranasally over a short period of time, it is easy for problems to occur.

Some tips for intranasal administration are:

  • It is advisable to pulverize the substance to a very fine powder before snorting it.
  • Do not always use the same nostril for snorting, but alternate between the two.
  • The sniffing straw should not be pointed at the nasal septum, but at the nasal turbinates (lateral), where vascularization is greater and absorption is better.
  • It is recommended to clean the nostrils well a few hours after the last dose of cocaine. Physiological saline (or slightly salty clean water) can be used. Saline irrigation can be used for several days (best with a syringe).

If you experiment with cocaine again I suggest you follow these tips. Also decrease the total dose.

Cocaine and topical anesthetics

I’ve recently used Cocaine and found it to only give me a numbing sensation in the nose (becomes a little runny as expected) and throat (after it settles in). But there isn’t a strong stimulate feeling whatsoever. I’ve had more of a buzz from large doses of coffee even. Is this normal or would higher purity coke cause a lack of speediness?
I was a regular user of Ritalin as a child (about 5 years or so) if that matters.

Originally posted in SR 2.0 . Reviewed

There is no cross-tolerance between caffeine and cocaine. Drinking large doses of coffee does not affect the effects of cocaine.

Previous consumption of methylphenidate does not cause chronic cross-tolerance with other stimulants.

Numbing sensations are often thought to be indicative of cocaine purity. Cocaine is a skin and mucosal anaesthetic but so are other local anaesthetics (lidocaine, tetracaine, benzocaine…) which have no mental effects.

In fact, this group of drugs is among the usual adulterants of cocaine. They are used precisely to produce these sensations.

From the information you provide, low-quality cocaine adulterated with other local anaesthetics seems a likely cause of these «numbing sensations» without mental stimulation.

By the way, this is the correct way to make a coke line.

Oral contraceptive and drugs interactions

Hi Doc,

My girlfriend has been in a panic lately about her contraceptive pill (mercilon). Previously she has always had a bar in her arm but switched 2 months ago to the pill. Do any of the following affect how well the pill works: Mephedrone, methylone, cocaine, mdma, alcohol or in any combination of the above?

Originally posted in SR 2.0 7/4/14 . Reviewed 8/2/23

There are no  significant pharmacological interactions between common  drugs and birth control pills. The use of substances you mention does not alter efficacy of birth control pills. Neither any other hormone-based method: patches, transdermal implants, vaginal rings …

Equally important, contraceptive efficacy of the «morning-after pill» is also not affected

There are some studies that suggest  pharmacological interactions between cannabinoids and some contraceptives . But these are experiments «in vitro» and do not seem to have any practical relevance in humans.

And the same goes for combinations. We will consider «combination» the use of moderate doses and reasonable frequencies of a few substances. «Drug salads» ( taking whatever anyone offers to you without  criteria) often have unpredictable effects, regardless of the use of contraceptives or any other medication.

In relation to drugs and hormonal contraceptives, one important exception is tobacco. Women who smoke tobacco are at increased risk of certain adverse effects.  Smoking increases hormone levels in the blood, which can lead to an increased risk of blood clots, myocardial infarction and stroke.

In addition, smoking is associated with a decrease in good (HDL) cholesterol levels and an increase in bad (LDL) cholesterol levels. This contributes also to cardiovascular problems.

It is therefore recommended that women using oral contraceptives do not smoke (especially women over 35 years of age). If a woman is unwilling or unable to quit smoking, it is reasonable to consider another method of contraception.

Like many other drugs, oral contraceptives are used on a daily basis.So, it is important not to forget doses in order to maintain their effectiveness. This can be significant in the context of a rave or party lasting several days. In any case, weekly or monthly contraceptives are available for people who have a tendency to forget to take a drug every day.

Cocaine dependence potential

Just out of curiosity.

How often a week doing coke up the nose will be heading for a serious habit?

I’ve found my cola usage is going up a bit now I have found some decent quality gear & I’ve been using 1mg Xanax to ease the comedown & help me fall asleep which it does perfectly.

I understand that everybody’s different with regards addiction & tolerance levels but any imput from you would be really appreciated

I’m going through about a gram per week, spread out from the weekend & a session midweek sometimes, would it be a good idea to slow down for a while as I find coke very moorish just lately which has got me thinking…

Thanks Doctor X, your a very worth while addition to the forum

Originally posted in SR 17/5/11 . Reviewed 9/2/23

The question is very difficult to answer…. How much sex is too much sex? How many drugs are too many drugs? In some situations there are objective parameters to measure normality versus disease (from obesity to hypertension). But in drugs things don’t work like that…..

In my opinion, it is not always the professional (doctor or whatever) who has the final say on whether someone is using or abusing drugs. There are scales and classifications that change every few years that can serve as a guide.

But at the end of the day, it is up to the user to measure whether his or her own drug use is appropriate for the personal, social, work or family activities he or she wants to pursue. It is also important to do the exercise of not using for a period of time and to see to what extent one feels (or not) the need to use substances in those circumstances where use is habitual.

In general, routine or cyclical patterns of use of substances with high addiction potential (in the case you mention, cocaine and benzodiazepines) end up causing problems of abuse or dependence (or «use disorder» according to the latest fashions). In my opinion, «a gram of cocaine every week» can cause problems in the medium term if it becomes routine. In your message you suggest that you think/feel you need to curb your pattern of use, follow your instinct….

By the way, this is the correct way to make a coke line.