Does methamphetamine interact with insulin?

From the Guidelines

Methamphetamine use is strongly contraindicated in individuals using insulin due to its significant impact on blood glucose management and the potential for severe health complications, including diabetic emergencies and cardiovascular issues. When methamphetamine is used, it typically causes elevated blood glucose levels as it stimulates the release of stress hormones like adrenaline and cortisol, which increase glucose production in the liver and reduce insulin sensitivity in tissues. For diabetic patients using insulin, this interaction can be particularly dangerous as it may require higher insulin doses during methamphetamine use, followed by potential hypoglycemia (low blood sugar) when the drug wears off. This creates a dangerous roller-coaster effect on blood glucose levels.

Some key points to consider in managing diabetes and potential interactions with substances like methamphetamine include:

• Coordinating food with the type of diabetes medicine, especially for those on insulin secretagogues or insulin, to minimize the risk of hypoglycemia 1.
• Avoiding substances that can complicate diabetes management, such as alcohol, which can have minimal acute or long-term effects on blood glucose but increase the risk of hypoglycemia when used with insulin or insulin secretagogues 1.
• The importance of carbohydrate counting or another meal planning approach to quantify carbohydrate intake for individuals with type 1 diabetes and insulin-requiring type 2 diabetes, to match mealtime insulin to carbohydrates consumed 1.

Given the potential for methamphetamine to cause significant fluctuations in blood glucose levels and complicate diabetes management, it is crucial for individuals using insulin to avoid methamphetamine completely. The risks associated with this interaction, including increased chances of diabetic emergencies, cardiovascular complications, and long-term damage to organs already vulnerable from diabetes, outweigh any potential benefits of methamphetamine use. Instead, focus should be placed on evidence-based diabetes management strategies, such as those outlined in recent guidelines for the management of diabetes 1.

From the FDA Drug Label

Insulin requirements in diabetes mellitus may be altered in association with the use of methamphetamine and the concomitant dietary regimen Methamphetamine may interact with insulin, as it can alter insulin requirements in patients with diabetes mellitus.

• This interaction is related to the use of methamphetamine and the patient's dietary regimen. 2

From the Research

Methamphetamine and Insulin Interaction

• Methamphetamine has been shown to induce insulin release in rats and mice, with a direct effect on the pancreas 3.
• However, the effect of methamphetamine on blood glucose levels in humans is more complex, with some studies suggesting a decrease in fasting blood glucose levels in methamphetamine abusers 4.
• Methamphetamine use has also been linked to an increased risk of diabetic ketoacidosis, particularly in individuals with insulin-dependent diabetes 5.
• Other studies have highlighted the potential of various drugs, including methamphetamine, to induce hyperglycemia and diabetes through mechanisms such as alterations in insulin secretion and sensitivity, and direct cytotoxic effects on pancreatic cells 6, 7.

Mechanisms of Interaction

• The exact mechanisms of methamphetamine's interaction with insulin are not fully understood, but may involve alterations in insulin secretion and sensitivity, as well as direct effects on the pancreas 3, 6.
• Methamphetamine use has been shown to increase the risk of hyperglycemia and diabetes, particularly in individuals with pre-existing diabetes or those taking other medications that affect glucose metabolism 6, 5, 7.

Clinical Implications

• Clinicians should be aware of the potential for methamphetamine to interact with insulin and increase the risk of hyperglycemia and diabetes 6, 5, 7.
• Individuals with diabetes or those taking medications that affect glucose metabolism should be closely monitored for changes in blood glucose levels when using methamphetamine 6, 5, 7.