Stimulants, MDMA and psychedelics

These drugs are less common than alcohol, nicotine and cannabis — but rarer doesn't mean less serious. This page covers what stimulants, MDMA and psychedelics do to someone managing type 1, where the danger point usually is, and the practical steps that lower the risk.

Speed, ice, MDMA, cocaine

Stimulants turn your engine up. You burn through carbohydrate like you're running a race you never agreed to — and your appetite is switched off, so nothing goes back in.

• Carbs burning. The same effect as a long workout you didn't eat for.
• Appetite gone. Food is the last thing you want for six or eight hours.
• Warnings masked. Racing heart, sweating, shaking — that's a hypo, and it's also just the drug.
• Heart strain. Blood pressure goes up. Cocaine is hardest on a heart that diabetes is already taxing.

The classic outcome is a serious hypo, hours in, at a party, while you feel incredible. The timing is the key point: the danger isn't usually at the peak. It's three or four hours in, when the carbs have gone. That's when to check, and when to eat even if you don't want to.

MDMA has its own problem: water

MDMA heats you up, keeps you moving, and stops your body clearing water properly. There are two ways to get this wrong, and they point in opposite directions.

Too little water. Dehydration pushes your blood sugar up and concentrates ketones. It's a direct road to DKA — and high blood sugar dehydrates you further.

Too much water. Downing bottle after bottle can dilute the salt in your blood to dangerous levels. This can be fatal on its own, without a single extra pill.

The water advice is a rate, not a target. Steady sipping — not catching up in one go.

MDMA can also cause irregular heart rhythms, which is a real concern if your diabetes has been hard to manage.

Acid, mushrooms, ketamine

These change what you see, hear and believe is real — for six to twelve hours with LSD. You are not going to count carbs, read a number off a sensor, or make a sensible dosing decision in that state.

Ketamine is its own thing. Confusion and memory blanks mean missed insulin, and at a higher dose you stop responding altogether — which looks exactly like a severe hypo to everyone around you. For friends, the rule is simple: if in doubt, treat it as a hypo and call for help.

The page What your friends should know is written for exactly that person.