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


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 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.



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.


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.


MDMA, amphetamines and breast-feeding

Should MDMA and amphetamines be avoided during lactation? Is it strictly forbidden or risks are acceptable?

Originally posted in SR 2.0 31/10/2013. Reviewed 20/2/22

The relation between MDMA and lactation is not clear. As far as I know, there are no published studies on this particular issue. Available data on amphetamine show that «In dosages prescribed for medical indications, some evidence indicates that amphetamine might not affect nursing infants adversely.». On the other hand, data from methamphetamine show that meth is secreted to breast milk and it should be avoided.



In my opinion, it is basic to avoid use that can be harmful to third persons. A person can asume risks for himself but not for others, even less a baby. So there would be three options:

1) Wait to finish lactation and then use MDMA or amphs

2) Interrupt natural lactation (use artificial milk) and use MDMA or amphs

3) Collect enough milk for 3-4 days (using a breast-pump), keep it in the fridge and use it during the following days to MDMA or amphetamines use.


MDMA post-loading with 5-HTP

MDMA post-loading with 5-HTP

I have read about using foods rich in triptophan (MDMA post-loading with 5-HTP). According to my sources, this diminish negative MDMA effects and reduce neurotoxicity. Do you have any food supplement recommendation to reduce the bad effect of MDMA?

Originally posted in SR 2.0 6/5/14 . Reviewed 20/2/22

Pre-loading/post-loading via herbal and/or pharmacological products in relation to the effects of MDMA is a relatively common practice (up to 40-70% of users, according to some studies) .

5-HTP (hydroxytryptophan) or tryptophan are the most commonly used substances. 5-HTP is the precursor of serotonin, the neurotransmitter allegedly responsible of MDMA  psychological effects . MDMA produces a rapid release of a large amount of serotonin in neurons.

However, this release is also believed to be the cause of the acute adverse effects that occur 24-48 hours after consumption This includes depressed mood and fatigue, as well as the potential neurotoxic effects.

To combat these adverse effects, some users turn to herbal supplements or tryptophan-rich foods: chocolate, peanuts, or bananas. Typical «post-load formulas» contain Vitamin C, magnesium, alpha-lipoic acid or green tea extract.These guidelines are based on recommendations in Internet forums or some books on MDMA.

  • Pre-loading (taking supplements before consuming MDMA) seeks to enhance the effects of the substance by theoretically increasing the amount of serotonin available.
  • Post-loading (taking supplements after consuming MDMA) aims to help the body recover from the potential adverse effects of MDMA. Neurotoxicity, oxidative stress, and depletion of certain neurotransmitters , linked to depression and other negative effects.

Interestingly, the «midweek blues» have only been reported in recreational users, while therapeutic use has been associated with  an «afterglow» in which residual empathogenic effects remain 24-48 hours longer. So this implies that the «crash» of MDMA has more to do with contextual aspects (lack of sleep, physical exercise, mixing with other substances…) than with its pharmacology.

Thus, users who use moderate doses and frequencies, occasionally, programmed and without too many excesses should not suffer very accentuated acute psychological adverse effects. There is also no evidence that, in the usual patterns of consumption in humans, MDMA produces irreversible neurotoxic damage. On the contrary, heavy users are more prone to such effects.

So,  data to support the use of post-load supplements are based on the subjective experience of users. There are no clinical trials that have evaluated this type of strategy. And there is also no consensus on appropriate dosages. Some authors recommend «50 mg of 5-HTP for 3 days 24 hours after the last intake». Others use doses of 100-300 mg for 5-7 days.

Post-MDMA intake of bananas, peanuts, or chocolate is unlikely to have any consequence (unless overindulged)

With the available data it is not possible to recommend a guideline or to consider its efficacy. Then.  a diet rich in bananas, peanuts and chocolate is unlikely to have any negative impact after taking MDMA. But it has not been shown to have any effect on either moderate users (in whom it is probably unnecessary) or intensive users (in whom it is probably ineffective for its intended purposes).


Sex on MDMA

What is sex on MDMA like?

I plan on using MDMA to engage in a sexual encounter with a very close friend. We’ll be using it together.Is sex on MDMA a good idea? What dangers should i look out for? what can I do to limit risks, or make the experience the best it can be??

Originally posted in SR 2.0 16/4/14. Reviewed 9/2/23

Opinions about sex on MDMA vary widely. It is often a matter of personal preference. But, certainly, is one of the «classical» combination for sex and drugs.  Generally, people tend to prefer engaging in sexual activity 3-4 hours after taking MDMA. At this point, the intense mental effects are beginning to subside, but the sensations of enhanced tactile stimulation and general well-being persist.

A Rollercoaster Ride for men

One potential issue for men is that MDMA can make it more difficult to achieve and maintain an erection. However, this effect diminishes after three to four hours for most people. Some people counteract this effect using anti-impotence drugs. This is an option in healthy persons and using reasonable dosages.

Another common experience for men using MDMA during sex is retarded ejaculation. This can be either an advantage or disadvantage depending on the person and the situation. Although many individuals prefer engaging in sexual activity after taking MDMA, some prefer it during the peak experience.

Is not just a question of erection, on MDMA you can explore thousands ways of creative and enhanced sexuality

MDMA: Sex enhancer or love potion?

Disinhibition can have positive aspects (especially if people know each other beforehand and are familiar with the experience). It may be easier to explore fantasies or propose activities that we repress in the usual state of consciousness.
If we are talking about sex with strangers, or people who have not previously experimented with MDMA, things may be different. It is important to maintain the measures to protect one’s own health  (contraceptives, PREP, condoms…). And be aware about self’s modified state of consciousness and impact on decisions.

Add a bit of paraphernalia to sex

To optimize the experience, it is best to look for an intimate space free of distractions and to adopt a good set and setting. Showers, bubble bath, massage, porn, erotic talk, fantasies, black light and UV paint, glow sticks, candy….Possibilities are unlimited.

This can involve being free of worries and leaving room for improvisation Moderate dosages (no higher than 100-120 mg) are recommended. Engaging in sexual activity is no more risky than dancing at a rave (from a cardiovascular point of view), so adding MDMA does not introduce significant differences. As always, general rules of risk reduction for MDMA apply.

LSD, MDMA and infliximab interactions

Hello I was wondering if you knew anything about tnf-alpha remicade(infliximab). I like to know if it is there are LSD, MDMA and infliximab interactions, dangerous for a person using this drug for IBD.

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

Infliximab is one of the most recent treatments available in inflamatory bowel disease (IBD, inflammatory bowel disease: Crohn’s Disease /Ulcerative Colitis). 

Infliximab is sometimes used intravenously in severe disease flares. In these circumstances the use of recreational drugs or psychedelics is contraindicated. The patient is usually hospitalized and in poor general condition. So he will not probably find psychedelics enjoyable. 

But, on other occasions it is used periodically subcutaneously. If the patient’s general condition (both physical and psychological) is acceptable, there are no data to assume that MDMA or LSD increase the risk significantly. An increase in adverse, toxic or toxic effects is not to be expected.