Navigating Addiction While Living with Type 1 Diabetes
Editor’s Note: Addiction is a complex disorder and mental health issue. Just like with Type 1 diabetes (T1D), your experience of addiction may vary. There are many stigmas associated with addiction, and finding help can be difficult and scary. If you need mental health support with diabetes and addiction, or a mental health provider who understands the unique pressures of living with diabetes, consult the American Diabetes Association’s Mental Health Provider Directory. For help with addiction treatment, contact SAMHSA.
Addiction is a chronic disorder and mental health issue that often results in extreme substance abuse. In 2016 alone, substance abuse killed more than 151,000 people in the US—63,000 from drug overdoses and 88,000 from excessive alcohol use. As dangerous as addiction can be for people without an existing disease or chronic illness, addiction can be even more of a concern for those living with type 1 diabetes.
Michaela, who lives with type 1 diabetes and has been sober for seven years, shared her story of addiction with us.
“I had this picture perfect childhood,” Michaela says. “I have amazing parents and I grew up in a middle class, Midwestern family. I played lots of sports and my dad was my coach on every team I played on. We went on family vacations to Florida and Disney and spent our summers boating on Lake Erie.”
Michaela was diagnosed with type 1 diabetes at the age of 11.
“Thinking back I can’t think of any classic triggers that caused me to start using drugs,” Michaela says, never having felt any kind of shame or insecurity around T1D. She began drinking alcohol with friends at the age of 16, although it never became an issue. But at 18, Michaela tried cocaine for the first time.
“From there I dabbled in meth and ecstasy but they were never really a problem for me,” Michaela says. “I could party on the weekends and still go to school and work. I could easily put those down and it wasn’t a regular everyday thing for me,” Michaela recalls.
“It wasn’t until my late 20s I started dating this guy who got me into pain pills. We started taking Vicodin and Percocet every now and then, but I loved them,” Michaela says. “They made me feel so good and nothing at all at the same time.”
Michaela began to experiment with stronger drugs such as morphine, often shooting up as opposed to taking them orally.
“From there, it progressed into my complete demise on heroin,” Michaela says.
Developing complications during addiction
Michaela admits to not having taken T1D into account at all when experimenting with drugs. “Drugs have a way of making everything in your life take a backseat to them,” Michaela says. “When I say everything, I mean everything. They become more important than anything and you don’t even know how it happened. You are not capable of caring.”
Michaela had a number of T1D-related complications throughout her experience with addiction, including two instances of DKA, pancreatitis and kidney infections.
“I would say a combination of things made me really decide to get sober,” Michaela says. “I had lost so much in those five years. You really do have to lose everything to make you realize you need to get sober. I was 32 with a criminal record, lost custody of my son, and I had nowhere to go but a grave. I had broken my parents’ hearts and my dad had just been diagnosed with cancer. He told me, ‘If I could give my life for you to get better, I would.’ I went to rehab a month later and I wasn’t messing around this time.”
Michaela also experienced severe difficulty obtaining the proper prescriptions and care around her type 1 diabetes, creating issues with the rehab process.
“I got (to rehab) on my admission day and the nurse would not admit me to the rehab because I didn’t have a current prescription for my insulin,” Michaela recalls. “At that time I had no job and no insurance. I had not been to the doctor in years. I was buying my insulin at Walmart just to survive,” she adds. “I remember yelling at her that heroin was going to kill me a lot faster than my insulin.”
Michaela went back to using heroin after she was turned away, but found a facility that was more sensitive to her situation three months later.
Hitting rock bottom
Dr. Kathleen Wyne, an endocrinologist at Ohio State, believes that people in active addiction who also have type 1 diabetes are no different than any other person with a substance misuse issue. However, how the individual may have reached the point of addiction can vary, and can often include the impacts of living with T1D.
“How they hit ‘rock bottom’ may be different,” Dr. Wyne says. “Severe diabetic ketoacidosis (DKA) and/or severe hypoglycemia may be the event that precipitates identification of the addiction. Having said that, we have many patients with frequent admission who still deny their problems with abuse—again, no different from any other person in active addiction.”
29-year-old Molly was diagnosed with type 1 diabetes in 2004, a month before turning 13.
“I had just moved across the country, hit puberty, and then was diagnosed with diabetes,” Molly recalls. “I immediately got in with a bad crowd because of my bad attitude. The first time I tried cocaine was April 14th, 2006.”
Molly had been experimenting with drugs for some time before trying cocaine, but never to the level of addiction.
“I quickly found myself addicted to cocaine,” Molly says. “I was using an ungodly amount, daily, for a couple of months. I overdosed in June of 2006. I had a heart attack, my kidneys were failing and my brain was swelling. I remember my heart rate being 220 when I arrived at the ER. While it was only a couple of months, it changed the rest of my life.”
Molly went to rehab, where she suffered from severe withdrawals for several weeks, until eventually being permitted to return home.
“I still smoked a lot of weed and took a lot of pills up until 2011,” Molly remembers, “But then I applied to EMT school and realized I had to quit.”
The effects that type 1 diabetes had on Molly’s mental health as a teenager was what she would refer to as “overwhelming.”
“I used drugs to cope,” she says.
Molly now has damage to her brain, heart, and has been diagnosed with kidney and liver disease. She also struggles with hypertension and high cholesterol.
“I abused my body for so long, because I was so angry at it for turning on me,” Molly says. “Now I have to try so much harder to maintain my health.”
“My goal in life is to help other people, and working with diabetics is a passion,” Molly adds. “I want to make a difference in the lives of young diabetics, so that maybe they can learn from my mistakes.”
Today, in addition to her job as a 911 dispatcher, Molly is working on her medical degree and plans on focusing on either endocrinology or emergency medicine.
Addiction in young people with T1D: not enough resources
Dr. Wyne believes that there is generally more literature on drug abuse in youth and adolescents with T1D than in adults with T1D.
“This is probably related to the fact that psychology is typically an integral part of pediatric endocrinology clinics but not at all in adult endocrinology,” Dr. Wyne says. “Also, the pediatric side is very much involved in paying attention to behavior changes because they are already struggling with issues with puberty, rebellion, and transition to adulthood.”
Dr. Wyne tells us that she has recently seen several adults with T1D who schedule endocrinology appointments to discuss planning for rehab that they are entering for either alcohol or opioids.
“In all cases they tell me the problem was already there but was exacerbated by COVID,” she says.
Whenever Dr. Wyne has a patient come to her with specific concerns about their opioid addiction, she is forced to send them to the Emergency Department.
“They do get the care they need, but there has to be a better way to get them access to the mental health system,” Dr. Wyne adds.
Although many in the T1D community have an awareness of eating disorders, Dr. Wyne believes that addiction has not been sufficiently addressed. She also notes that increased awareness of cues for addiction in the endocrinology department is essential going forward.
“We get so caught up in dealing with the diabetes, we tend to forget addressing all the other parts of life,” Dr. Wyne says. “This gives me a chance to remind people that if one does not have control of their life then they can not control their T1D. A clinic visit should be about more than sugar and insulin dosing; we need to talk about life.”