Substance abuse with diabetes, doctors who don't like the way you're using your insulin pump — these are just a few of the prickly issues we deal with here at our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Send us your queries related to life with diabetes — nothing is off-limits here! (except of course specific medical instructions for your own care; that's what doctors are for)

{Need help navigating life with diabetes? Email us at [email protected]}

 

Megan from California, type 1, writes: I am addicted to benzodiazepines, if you know what they are, and I'm wondering if the drug abuse can affect or be the reason I'm a diabetic now? I'm having a really hard time coming off them ... I guess my question is, can it affect my blood sugars?

Innovation 2015

Wil@Ask D'Mine answers: Oh yeah, I know what benzos are. But just in case some of our readers don't: They're a highly addictive family of depressant meds—tranquilizers in plain English—intended to counteract seizures, reduce muscle spasms, relieve anxiety, or serve as sleep aids. They act in a dose-dependent manner. Small doses have a mild sedative effect, middle of the road doses chill people waaaaay out, and whopping doses knock your lights out. Ummm... and I'm not even sure if I should mention this, but benzos are one of the media-hyped "date rape" drugs.

Worldwide, more than 2,000 different benzos are in production, but here in the U.S. there are 15 different types that are FDA approved including the trade names Ativan, Librium, Versed, Xanax, and my personal favorite: the 38-year-old blockbuster Valium. More than 108 million prescriptions are written for benzos in the U.S. annually, placing them at the number 11 slot of the top-20 most prescribed types of meds. For perspective, in sixth place, are anti-diabetes meds, with 165 million prescriptions. (Inquiring minds want to know the top three? In first place are cholesterol meds, in second place are antidepressants, and in third place are narcotic pain killers. Welcome to PharmaLand.)

Oh, and just so none of you judgmental-types mistake Megan for a low-life, benzos are handed out like candy by primary care docs, are highly addictive, and benzo addiction is a lot more common than you might suspect. Try this on for size: six percent of the U.S. population has abused benzos at one point or another.

In addition to being highly addictive, benzos have some nasty side effects from long-term use. As the drug's effect is on the central nervous system, long-term bad shit includes amnesia, hostility, irritability, and funky dreams. Withdrawal is also markedly wicked, not unlike the DT's suffered by severe alcohol abusers.

I remember my wife's grandmother, a sweet little old lady of 86 years old, had gotten addicted to very high volumes of Ativan prescribed by her primary care doc. She had been hospitalized for some other issue and the hospitalist (who must have gotten his medical degree in Mogadishu) stopped her Ativan cold-turkey, rather than tapering it down as any first year Resident would know to do. That night she attacked a nurse and pulled out huge clumps of the poor woman's hair.

She had to be restrained and we were called in.

Grandma had a wild-animal look in her eyes when I arrived on the scene, and she was convinced that I'd been replaced by an imposter. "That can't be Wil, he's too skinny!" (I had lost around 70 pounds following my diagnosis.) As we wheeled her out to the car she was screaming at the top of her lungs that she was being kidnapped by strangers. Oh, and she also started screaming that there was a bomb in the hospital and everyone should run for their lives. Interestingly, no one came to her rescue and no one ran for their lives. I don't know if that says more about our society or how respectable I look.

Moving on... did your addiction cause your diabetes? Well, we don't really know what causes type 1 diabetes, but I think we can be pretty confident that it isn't benzos or we'd have a helluva lot more type 1s on our hands. And let's not forget that benzo-addicted kids, while not unheard of, are a lot less common than benzo-addicted adults — while most newly diagnosed type 1s are kids.

As to the effect the benzos might have on your blood sugar, not much, or least not much that I can find. (Although apparently scarfing down a lot of carbs can make withdrawal symptoms worse in some people trying to kick the habit.) Of course, coming off of benzos is going to entail some serious withdrawal, which can be pretty grueling, as you know. I wouldn't be surprised if you had some trouble with blood sugar control during this time as your body will be putting up quite a fight.

For what it's worth, I did find one source, from the Japanese Journal of Pharmacology, reporting on a study in Brazil, on diabetic rats... and at this point I wonder if I should even go on? Oh well, what the hell: this study showed that if you give diabetic rats benzos it increases their insulin levels and lowers their blood sugar. But I couldn't even find out how many rats were studied.

So if anything, your addiction should help lower your blood sugar, not make higher.

That said, I think you should continue your efforts to get yourself clean, and to do that you need some folks on your side. You'll need to come off the benzos slowly. You'll need expert medical guidance, some counseling, and a ton of support from friends and family. And don't forget your online family. We're here for you, Sister.

Kellan from Ireland, type 1, writes: My endo wasn't impressed when he was going through my pump and discovered I was having up to 12 boluses per day. Even though I'm achieving much better numbers now than I ever was, he feels like I need to change this. If I'm achieving better numbers, then what's the problem??

Wil@Ask D'Mine answers: For about 12 years, my mom's VCR flashed "12:00" all the  time because no one could figure out how to set the damn clock and it really didn't matter because she never did any timed recording, anyway. Did that make the VCR useless? Heck no. She could still make Blockbuster runs or hit the record button to tape something she was watching.

Was she using the VCR wrong? Maybe. But who the f--- cares? It was working for her.

And speaking of little old ladies, I have a little old lady patient we put on a pump about a year ago (she chose the pink one). Epic medical politics were involved, as her primary care doc was in another city but couldn't sort out her diabetes so she sent the lady to us. We decided a pump was the best solution, but her particular insurance would only accept a pump prescription from an endo. Then the endo wanted the little old lady to see the CDE in the endo's office, and this particular CDE was a complete idiot. No really, she was. The patient was a type 2 but the CDE set the bolus limit so low the pump wouldn't give the patient any insulin at meals (type 2s need more). But I digress.

Anyway, this little old lady had, pre-pump, been doing absolutely terribly. Her A1C was through the roof and her blood sugar was highly variable. Like all over the map. Ambulances were called for lows. She spiked into the 500s. She was what I like to call a CTW: a certified train wreck.

Over a couple of months I got her back on track. Her mornings ran a hair low, 90ish, but stable, and her peak after-meal readings were coming in around 160. It was a frickin' miracle in my book.

But her endo had a fit.

Why?

Because she wasn't counting carbs and using the bolus wizard.

Did I mention this lady has had a couple of strokes? Or that her eating patterns are very uniform from day-to-day? I didn't think she was up to learning carb counting, so I did an end-run and had her use a flat-rate meal bolus from the pump. We got a good basal rate set up, and worked out an effective correction ratio for her rare high blood sugars, all of which were triggered by tangles with her alcoholic low-life daughter. (Not that alcoholics are low-lifes; this woman just happened to be both.)

Was I using her pump "right"? Not really. Did I give a shit? Not really. Look, a pump is just a fancy syringe. It's "job" is to help PWDs control their blood sugar to the best of their abilities. I was judging our success by our results. Silly me.

The endo blew a gasket 'cause we weren't using the pump to the fullest extent possible. She got so mad she yelled at my little old lady and made her cry. My patient came back to me with her tail between her legs, depressed and defeated that her 6.1 A1C and lack of ambulance rides just wasn't good enough for the endo. "I guess I have to learn to carb count," she told me.

Or we can use the phone book, I said.

"But how will the phone book help me count carbs?" she nearly wailed.

I won't, I said, but we can use it to find another endo.

So I'll confess to being willing to break all the rules. When it comes to health, at least, I do believe the ends justify the means. My mom's VCR served her just fine with no idea what time it was. My little old lady controlled her diabetes just fine using 10% of her pump's capabilities.

Kellan, I think if you have to take correction boluses 12 times per day it's true that your pump is not programed to its fullest capabilities. And I guess that in theory, if you took too many boli too close together you could "stack" your insulin and give yourself a down-stream low. But if you're not having lows, don't mind taking the 12 boli, and your diabetes is well-controlled, then the problem is your endo's, not yours.

Ireland, huh? I think you and your pump should go to the nearest pub, get out the phone book, and find a new endo.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.