Methamphetamine use and the risk of diabetic ketoacidosis

Lewis, Daniel; Heuvel, Corinna van den; Kenneally, Michaela; Byard, Roger W.

doi:10.1177/00258024211020936

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…10 Methamphetamine has also been detected in forensic autopsies in infants as young as one month of age, 11 and may be associated with exacerbation of underlying medical conditions such as cardiac disease and insulin-dependent diabetes mellitus. 10,12 In the present study, 30% of victims of homicide had methamphetamine detected on toxicological screening of blood, which is significantly higher than in the general Australian population (30% vs 5.8%, p < 0.001). 9 No significant changes in incidence could be demonstrated over the decade of the study, although it is recognised that the numbers per year are quite small (Figure 1).…”

Section: Discussioncontrasting

confidence: 48%

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Methamphetamine use in homicide victims

2023

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Methamphetamine use is increasing in the Australian population. It has a known association with violent and erratic behaviour and with an increased risk of unnatural deaths. To determine whether victims of homicide have significant exposure to methamphetamine 100 randomly selected de-identified homicide cases from 2012 to 2021 were accessed from the Forensic Science SA (FSSA) Pathology Database to determine the type of homicide and whether methamphetamine was detected in the blood. A total of 76 males and 24 females were found (M:F = 3:1). Of these, 30 victims (30%) had methamphetamine detected in blood, consisting of 26 males and 4 females (M:F = 6:1; male age range 18–53 years, average 36.8 years; female age range 28–63 years average 44.8 years). Levels of methamphetamine ranged from 0.02 to 3.3 mg/L with an average of 0.64 mg/L, with the highest numbers of positive cases occurring in victims of gunshot wounds (45.5%), and the lowest in those with lethal blunt force trauma (23.5%). This study has demonstrated that victims of homicide in an Australian population are more likely to have used methamphetamine than members of the general population. The reasons for this remain unclear although involvement in a drug selling environment may be an important determinant.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Methamphetamine use in homicide victims

2023

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“…that may have an effect of inducing or hindering diabetic control, there can be direct physiological effects of substance use and drugs of abuse in particular. Such drugs are typically associated with certain central nervous system (CNS) and pharmacodynamic effects resulting in categorisation as stimulant, depressant, or hallucinogenic in nature [8].…”

Section: Diabetes and Substance Usementioning

confidence: 99%

“…The subsequent effect on the CNS increases the heart rate of an individual and produces an increase in activity. Thereby, potentially increasing carbohydrate metabolism may result in hypoglycaemia in a diabetic individual without the necessary dietary replenishment [5,8]. In addition, stimulant drug action such as cocaine involves triggering the adrenal medulla to release catecholamines such as noradrenaline (norepinephrine) and adrenaline (epinephrine) [2].…”

Section: Stimulants and Hallucinogensmentioning

confidence: 99%

Diabetes and substance use: a perspective within drug rehabilitation

Alhassan,

Elrashid,

Alshehhi

et al. 2023

Exploration of Medicine

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Diabetes mellitus has become increasingly more common and diagnosed within the global population. Coupled with the continued prevalence of substance use, there are some distinct considerations for users suffering (knowingly or unknowingly) from type 1 or type 2 diabetes. The various different types of drugs of abuse including central nervous system stimulants, depressants, and hallucinogens present varying direct and indirect complications for diabetes based on their physiological and psychological effects ranging from non-compliance with medication to an increased risk of hypoglycaemia, hyperglycaemia, and/or ketoacidosis. This perspective highlights these issues supported by the drug history and toxicological findings in patients undergoing drug rehabilitation in the United Arab Emirates (UAE) demonstrating the use of alcohol, amphetamines, benzodiazepines, cannabis, opiates/opioids (especially tramadol), pregabalin, and synthetic cannabinoids. Physicians and drug clinic professionals should be aware of the contraindications of substance use and diabetes with a view to educating patients and healthcare professionals within such clinical settings.

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“…It is unknown whether this high rate is unique to donors with this disease or similar across all study groups. Alcohol, cocaine, marijuana, and methamphetamine use have been linked to diabetic ketoacidosis (DKA), possibly due to insulin omission while using these substances versus a direct impact on insulin secretion and glucose metabolism (5)(6)(7)(8)(9). Additionally, very heavy alcohol consumption and smoking are well known risk factors for chronic pancreatitis, with alcohol, cocaine, and opioid use linked to presentations of acute pancreatitis and altered insulin secretion profiles (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies

et al. 2021

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Access to human pancreas samples from organ donors has greatly advanced our understanding of type 1 diabetes pathogenesis; however, previous studies have shown that donors have a high rate of substance use, and its impact on pancreatic histopathology in this disease is not well described. One-hundred-thirty-one type 1 diabetes and 111 control organ donor pancreata from persons 12-89 years of age (mean 29.8 ± 15.5 years) within the Network for Pancreatic Organ donors with Diabetes (nPOD) were examined for insulin positivity, insulitis, amyloid staining, acute and chronic pancreatitis, and chronic exocrine changes (acinar atrophy, fibrosis, fatty infiltration, or periductal fibrosis); findings were compared by history of substance use. A secondary analysis compared exocrine pancreatic histopathologic findings in type 1 diabetes versus control organ donors regardless of substance use history. We observed a high but congruent rate of substance use in type 1 diabetes and control organ donors (66.4% and 64% respectively). Among donors with type 1 diabetes (but not controls), islet amyloid (OR 9.96 [1.22, 81.29]) and acute pancreatitis (OR 3.2 [1.06, 9.63]) were more common in alcohol users while chronic exocrine changes (OR 8.86 [1.13, 69.31]) were more common in cocaine users. Substance use impacted the pancreata of donors with type 1 diabetes more than controls. Overall, despite similar rates of substance use, acute pancreatitis (15.3% versus 4.5%, p=0.0061), chronic pancreatitis (29.8% versus 9.9%, p=0.0001), and chronic exocrine changes (73.3% versus 36.9%, p<0.0001) were more common in type 1 diabetes donors than controls. Alcohol and/or cocaine use in type 1 diabetes organ donors increases exocrine pancreas pathology and islet amyloid deposition but does not affect insulitis or insulin positivity. Exocrine pathology in type 1 diabetes donors is common, and further study of the pathophysiology of these changes is needed.

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Methamphetamine use and the risk of diabetic ketoacidosis

Cited by 5 publications

References 23 publications

Methamphetamine use in homicide victims

Methamphetamine use in homicide victims

Diabetes and substance use: a perspective within drug rehabilitation

Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies

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