From the Guidelines
Individuals with alcohol use disorder should not take exogenous insulin as a method to increase alcohol intoxication, as this practice is extremely dangerous and potentially life-threatening. This practice, sometimes called "skitching," involves deliberately injecting insulin without medical need to induce hypoglycemia (low blood sugar), which can enhance alcohol's effects and accelerate intoxication. When combined with alcohol, insulin can cause a more rapid drop in blood glucose levels, potentially creating a more intense feeling of drunkenness. According to the most recent and highest quality study available 1, moderate alcohol consumption has no acute effect on glucose and insulin concentrations, but carbohydrate coingested with alcohol may raise blood glucose. However, this study also emphasizes the importance of limiting daily alcohol intake to a moderate amount (one drink per day or less for women and two drinks per day or less for men) to reduce the risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues.
The combination of alcohol and insulin is particularly hazardous because alcohol already impairs the liver's ability to maintain normal blood glucose levels, and adding insulin dramatically increases the risk of severe hypoglycemia. Additionally, the symptoms of hypoglycemia (confusion, dizziness) may be mistaken for alcohol intoxication, delaying potentially life-saving treatment. This practice is not medically sanctioned and represents a serious form of substance misuse that requires immediate intervention and treatment for both the alcohol use disorder and the dangerous misuse of insulin.
Some key points to consider include:
- Limiting daily alcohol intake to a moderate amount to reduce the risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues 1
- Consuming alcohol with food to reduce the risk of hypoglycemia 1
- Avoiding excessive alcohol consumption, which can contribute to hyperglycemia 1
- Recognizing the symptoms of hypoglycemia and seeking medical attention immediately if they occur 1
Overall, the use of exogenous insulin to increase alcohol intoxication is a dangerous and potentially life-threatening practice that requires immediate intervention and treatment.
From the Research
Exogenous Insulin Use in Alcoholics
- Individuals with alcohol use disorder may experience disruptions in glucose metabolism, leading to hypoglycemia or hyperglycemia 2, 3.
- Chronic alcohol consumption can cause beta-cell hypofunction, resulting in decreased insulin response to glucose loads 2.
- However, moderate alcohol consumption has been associated with improved insulin sensitivity and reduced risk of type 2 diabetes in some studies 4, 3.
- The relationship between alcohol consumption and insulin resistance is complex, with a U-shaped curve suggesting that moderate consumption may have beneficial effects, while heavy drinking or abstinence may increase insulin resistance 3.
Mechanisms and Effects
- Alcohol consumption can inhibit gluconeogenesis, reduce secretion of counterregulatory hormones, and lead to inappropriate behavior, increasing the risk of hypoglycemia 3.
- Exogenous insulin use in individuals with alcohol use disorder may be necessary to manage glucose levels, particularly in those with co-existing diabetes or insulin resistance 5.
- However, the use of exogenous insulin in this population requires careful consideration of the potential risks and benefits, including the risk of hypoglycemia and the impact on glucose counterregulation 5, 3.
Studies and Findings
- A study published in 1993 found that chronic alcohol consumers had decreased insulin response to glucose loads, suggesting beta-cell hypofunction 2.
- A 2015 systematic review and meta-analysis found that moderate alcohol consumption was associated with reduced HbA1c and fasting insulin concentrations, but had no significant effect on estimated insulin sensitivity or fasting glucose 4.
- Another study published in 2009 found that moderate alcohol consumption had a minimal impact on enhancing insulin sensitivity in nondiabetic, insulin-resistant individuals 6.