What you need to know about opioids + diabetes

Understand how opioids affect diabetes and why people with diabetes are at higher risk of opioid misuse.

Ophelia team
Opioids and diabetes
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Fact checked by
Erica Lyons, DNP, MS, APRN, FNP-BC

With tens of millions of prescription, synthetic, and illicit opioid doses being taken in the United States each year and high levels of opioid misuse and overdose across the country, it should come as no surprise that people with chronic medical conditions are caught in the midst of a crisis. Those with diabetes may be particularly susceptible—in fact, rates of recreational drug use among people with diabetes are higher than average. This makes it crucial for these individuals and their friends and family to understand how drugs affect people with diabetes.

Why people with diabetes may use opioids

Despite all the stereotypes around drug-seeking behaviors and illicit opioid markets, the fact is that the vast majority of individuals who develop opioid use disorder (OUD) begin using these drugs for medical reasons and have legitimate prescriptions from their medical providers. This is just as true for people with diabetes, who may develop neuropathic pain as their condition persists. Commonly referred to as diabetic neuropathy, this condition is the result of nerve damage caused by the numerous effects of insulin resistance 

As many as half of diabetes patients will develop peripheral neuropathy, and around 30% will develop autonomic neuropathy. Mild neuropathy can be managed through monitoring and lifestyle adjustments, but patients who experience chronic pain due to nerve damage may be prescribed treatment. 

Many clinicians continue to prescribe opioids as painkillers for symptoms of diabetic neuropathy, but this comes with risks. Any continued opioid use increases the chances of developing dependence on the drug, and higher doses may be needed as patients develop a tolerance. Additionally, a growing body of research shows that opioids are not effective for diabetic neuropathy pain management. This has been known for decades, but aggressive marketing from pharmaceutical companies has led to clinicians prescribing opioids despite their relative inability to relieve pain caused by diabetic neuropathy.

How do drugs affect diabetes?

In general, those who use drugs recreationally are more likely to experience problems with glycemic control. Many recreational drugs impact a person’s appetite, wakefulness, and routine, and diabetes management requires strict, regimented treatment. Any disruption can cause a hyper- or hypoglycemic incident, which can put a person’s health at risk.

Opioids, in particular, can complicate diabetes treatment because hunger and drug cravings are often linked in the brain. During a hypoglycemic event, a person will usually become hungry; but for an opioid user, this can also cause drug cravings. These drug cravings may even take precedence over hunger, causing the patient to forgo eating, which worsens their hypoglycemic state. 

Because certain opioids, like heroin or fentanyl, are commonly taken by injection, some diabetic opioid users find that insulin injections trigger their cravings. Switching to an insulin auto-injector tends to help, but the problem may persist.

What are the risks?

Individually, diabetes and OUD are taxing on the body and can lead to long-term health complications and the need for medical treatment. Together, the potential for problems only multiplies. Opioid misuse is linked to issues with the kidneys, veins and circulation, and the liver. The damage sustained by these systems because of opioid use can worsen the effects of diabetes on the body and make it harder for the body to manage healing and repair. Long-term pioid misuse can also cause further nerve damage and deterioration, worsening the effects of neuropathy and increasing the associated pain.

In addition, people with diabetes and OUD are more likely to underreport their glucose levels and have trouble managing their food intake. This can lead to an increase in hypoglycemic and hyperglycemic events, which are damaging to the body’s systems. Other impacts on the endocrine system include hypogonadism, hyperglycemia, and disruption of the pituitary gland’s typical hormones.

What painkillers can people with diabetes take?

If possible, opioid use for pain relief should be avoided, especially when seeking relief from pain associated with diabetic neuropathy. Instead of turning to opioids, doctors and patients should explore other options.

For standard pain management after an injury or surgery, non-opioid analgesics, such as aspirin and acetaminophen, are the best options. NSAIDs, like ibuprofen, may be safe for most people with diabetes, but those with kidney disease or other major kidney problems should avoid it since it is hard on the kidneys and may exacerbate pre-existing issues.

When seeking treatment for chronic pain related to diabetic neuropathy, new guidelines advise doctors to explore the use of serotonin-norepinephrine reuptake inhibitors (SNRIs), sodium channel blockers, gabapentinoids, and tricyclic antidepressants. All these medications have been shown to be effective when managing diabetic neuropathy pain, and gabapentinoids are already widely used to treat other forms of chronic pain. Some non-pharmaceutical options may also help, such as cognitive behavioral therapy, topical capsaicin, and a doctor-approved exercise routine.

Treating OUD gives you one less thing to worry about

Don’t let OUD complicate diabetes management. Ophelia’s telehealth model makes it easy to connect with a clinical care team and start the intake process. If Suboxone® or another buprenorphine-naloxone treatment is right for you, we’ll make sure the prescription gets to your pharmacy and into your hands. Our approach to OUD treatment focuses on continuing support that fits into your real life.


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