Drugs affect the brain and nervous systems and will make it much more difficult to manage something like diabetes. Many drugs make you forgetful and the risk of ketoacidosis will increase if you have not taken enough insulin or missed your injections. A person taking drugs is at high risk of developing hypoglycaemia since drugs make you think less clearly. If friends know about your diabetes and how to treat hypoglycaemia, they may be able to help (unless they also are too heavily affected by drugs or alcohol). Unless the drug user wears a diabetes ID, it may take some time to get appropriate help, even if the police or ambulance staff intervene.
Narcotics and other illegal drugs are likely to be very addictive, so if you start using them you will have great difficulty giving up without help. If you have diabetes, you must understand that it is completely inappropriate from a medical point of view, as well as extremely risky, to use, or even try, any type of illegal drug.
Certain drugs may have specific extra risks associated with the blood vessels. Amphetamine is known to damage the linings of blood vessels thereby increasing the short-term and long-term risks of diabetes complications. Many people who are drug users would find it extremely difficult to take good care of themselves and their diabetes while continuing their drug use, because of the behavioural aspects of drug use. Casual drug users would have the same problems as those of other medications that interfere with rational self-care at the time.
Uppers like amphetamine (speed, whizz, sulph), methamphetamine (crystal, glass, ice), ecstasy (E, pills, doves) are stimulants that give more energy and confidence. This makes them popular at clubs, parties and raves. There is a risk of dehydration when the body loses fluid through continuous dancing or other strenuous activity, which is a particular concern for anyone with diabetes. Uppers can suppress appetite, and combined with dancing there is a risk of experiencing severe hypoglycaemia. In this sense these drugs can be extremely dangerous for a person with diabetes, especially if not enough extra fluid is taken or the extra bedtime snack is forgotten. Two cases of ketoacidosis in teenagers taking ecstasy have been reported.
Cocaine (coke, charlie, snow) is also used to produce “highs” and increase confidence. The price of these drugs has come right down in recent years meaning that they area available as street drugs rather than just for the rich and famous. Cocaine is a Class A drug and, particularly in the form of crack, can be very addictive.
This is a group of drugs that are used in a controlled way by doctors, prescribing them to people who have difficulty sleeping, or suffer from anxiety. But there is a “black market” for them too and they are used illegally as “recreational drugs”.
The best known drug in this group is temazepam. This can make you feel relaxed and sleepy but, if you take a larger dose, it can have similar effects to a large amount of alcohol. It can make you very talkative or overexcited, and sometimes aggressive. It also gives you a false sense of confidence and undermines your judgement. It would certainly be very difficult for you to be aware that your blood glucose level was too high or too low, and may even cause you to forget to take your insulin.
Use of marijuana (cannabis, hash, blow, and weed) has been viewed as less harmful than the use of “hard drugs” such as heroin, cocaine or amphetamines. In 2005, the Home Office published a new report showing that cannabis can, in fact, cause significant harm – both to physical and psychological health.
In terms of making rational decisions about complex activities such as driving or diabetes self-management, cannabis is likely to impair the judgement in much the same way as too much alcohol. Combining cannabis with alcohol (as often happens) adds special risks for making diabetes-related decisions about, for example, when to wake up the next day. Many people who take cannabis find themselves becoming especially hungry and want to eat everything in sight, especially junk food (the “munchies”) which will raise the blood glucose level considerably.
Hallucinogenic drugs alter your perception of the outside world. Lysergic acid or LSD (acid) found its way into the hippy culture of the 1960s and 70s. Although less widely used, it is still available now. Taking an acid tablet or “tab” can take you on a bizarre and dreamlike journey, or one that is a nightmare beyond your wildest imaginings. Even if you have taken acid before, the effects are unpredictable and trips usually last between 7 and 12 hours.
Another common hallucinogenic drug, ketamine hydrochloride (ketamine, K) was developed originally for use in hospital anaesthetics but the bizarre effects it can have means it is rarely (if ever) used in this way for humans now. Much of the ketamine that is sold on the street now was originally intended for veterinary use. As the drug was originally developed as an anaesthetic, it can lead to loss of physical sensation and even ability to move, as well as hallucinations and out of body experiences. The effects can be particularly alarming if it is mixed with alcohol. Anecdotal evidence suggests that is may be used as a “date rape” drug.