Psychoactive Drugs, Alcohol, and Severe Hypoglycemia in Insulin-treated Diabetes: Analysis of 141 Cases

Background: 

Alcohol consumption is a well-established risk factor for severe hypoglycemia in patients with insulin-treated diabetes. It has been estimated that alcohol use is involved in up to 19% of severe hypoglycemic episodes. The use of psychoactive drugs has become common and is particularly widespread among young people. As with alcohol, these drugs can also increase the risk of accidents and trauma. Whether the use of psychoactive drugs increases the risk of severe hypoglycemia in patients with insulin-treated diabetes was determined.

Methods: 

A prospective case series of adult patients (18 years and older) with known insulin-treated diabetes was assembled to assess and compare the frequency of use of psychoactive drugs and alcohol before episodes of severe hypoglycemia. Severe hypoglycemia was defined as the need of assistance from another person to restore glycemic level. A venous blood sample was drawn from each patient after treatment, and all specimens were screened for 66 of the most commonly used pharmaceutical drugs and 6 illicit drugs that could affect cognitive function and were available in Denmark.

Results: 

Psychoactive substances were identified in samples from 31% of patients (Table 2). Alcohol was detected in 17% of samples, with a median plasma ethanol concentration of 50 mg/dL. The most commonly occurring pharmaceutical drugs were antidepressants (5%), benzodiazepines (4%), and opiates (2%). Among the illicit drugs, marijuana was identified in 5% of the samples, and amphetamines were present in 1% of samples. Only 4% of samples were positive for both alcohol and drugs; thus an association between alcohol and drugs was not detected. The identification of illicit drugs was confined to patients younger than 50 years.

Conclusions: 

Persons with diabetes are informed of the relationship between alcohol consumption and the risk of severe hypoglycemia and advised to avoid excessive alcohol intake. It is possible that younger patients have been attracted to use psychoactive drugs that were not known to cause hypoglycemia. The increased acceptance of recreational use of these drugs among some segments of the population may be reinforcing this behavior. Health care providers should be cognizant of the possibility of use of psychoactive drugs by patients with diabetes and the need to advise these patients to avoid such drugs as diligently as they avoid alcohol. A need exists for additional studies to determine whether a causal relationship is present between recent drug use and severe hypoglycemia.