Stimulants, blood sugar and endocrinology

November 6, 2018 12:37 PM

I'm looking for high-quality (ideally: peer-reviewed, large cohort) information on the effects of amphetamine stimulants (eg Adderal) on blood glucose levels and insulin response. How does long-term prescription stimulant use affect blood glucose levels?

From looking around, a lot of people are also looking for similar information, but get low-quality responses (anecdotes from non-specialist med students, bullshit woo dieticians, pseudoscience from body builders, etc.). I'm specifically concerned with the effects of amphetamines on glycogenolysis and gluconeogenesis, and epinephrine production and response. I'm willing to bet that MeFi's high librarian and researcher quotient will turn up better resources than reddit lift bros. I know that stimulant use can be associated with hypoglycemia, but stimulants also seem to be agonists for insulin inhibition, and I'm interested in the long-term effects of that.

posted by anonymous to Health & Fitness (7 answers total)

I don’t have any specific sources, but I would try to look at research by Dr Russell Barkley on the topic. He’s talked about glucose in the brains of people with adhd, and he’s a big fan of using stimulants to treat adhd. I don’t know if he’s got research on both topics, but it would not surprise me.

However, I suspect his research is going to be geared towards people with ADHD, as there is some evidence that we use glucose differently. If you’re looking in normal folks, I don’t know where that might be or if that could be in similar research.

I do recall reading some time ago that guanfacine, a non-stimulant adhd medication changes glucose use in the brain of those with adhd. I do not have a source unfortunately, it was something I just remember researching.

Sorry I didn’t have more, but hope this gives you something to look for (assuming you don’t have this info already)

Please share what you find, it sounds like a great topic I’d like to know more about.
posted by [insert clever name here] at 12:51 PM on November 6, 2018

Additionally, this might be two places you’ve looked already, but I would look at /r/adhd and bluelight.org. Lots of smart people, and while info is often uncited, many do either cite their work or give some ideas to where you can find real research.
posted by [insert clever name here] at 12:56 PM on November 6, 2018

I'm a librarian, but not a medical librarian, but intrigued enough by this question that I started poking around. This isn't exactly what you want, but it might lead to other research, both in the research they cite and those that cite these articles (look up the article title in Google Scholar and click on "Cited by,").

"The Body Mass Index, Blood Pressure, and Fasting Blood Glucose in Patients With Methamphetamine Dependence" (I think it's open access and you should be able to get it).

"Effect of methamphetamine on the fasting blood glucose in methamphetamine abusers" (not sure if that one's open or not).

And now I am at the edge of my ability to understand these concepts. Hope this was somewhat helpful!
posted by bluedaisy at 1:16 PM on November 6, 2018

Are you a diabetic yourself? If you are you should run studies on yourself! I have. I know you want science and I'm afraid I don't have it.

I'm a well controlled diabetic with ADHD and I didn't notice a change in insulin sensitivity when I started taking Adderall or Adderall XR. I DID notice increased appetite, which would absolutely change insulin sensitivity depending on if my diet changed.

I think this would be incredibly difficult to study. Even in a controlled environment it would be hard to prove that specifically Adderall was the cause in a change of insulin sensitivity or length of action. There are so many other things that contribute to bloodsugar. At best you'd get correlation.
posted by Bistyfrass at 3:52 PM on November 6, 2018

I'm also T1 and took generic Adderall for an extended period. No change in fasting BG or in my overall BG profile. There were isolated occasions when I'd find myself with a lot of nervous energy to burn and I'd dip a little low if I forgot to have a snack before working it off, but not on a regular basis.
posted by The Underpants Monster at 5:01 PM on November 6, 2018

If these medicines had a clinically important important effect on blood glucose levels or insulin sensitivity, they would be used for people with diabetes. They are not main-line treatments in that disease. Granted, I have heard of the odd case of the anorexigenic effect of these drugs used in children with ADHD and childhood obesity, and in one case to help control a rising A1C through weight loss. There are better drugs for that purpose. Topirate, GLP1 agonists, naltrexone/bupropion, and lorcaserin have documented weight controlling effects that modestly reduce other metabolic markers, including some you mentioned.

In short, there is not a study for everything under the sun. There doesn’t need to be. If it worked better than other drugs for these purposes, it would be used. It is not indicated for those purposes, or even used off label for those purposes, so it is reasonable to assume that it is worse than existing approved treatments for weight loss and A1C reduction.
posted by metasunday at 8:58 PM on November 7, 2018

I am a doctor, type 1, and ADHD (prescribed Adderall).
Science wise - Epinephrine and norepinephrine (the main neurotransmitter activated by amphetamines) are stress hormones. Stress hormones raise blood sugar.
Experience wise - yes, my blood sugars consistently spike after taking Adderall.

Another article you (and type 1's especially) might find interesting is on the effects of blood sugar levels on amphetamine activity: https://www.sciencedaily.com/releases/2007/10/071017090131.htm
posted by DrBecks at 6:59 PM on August 8, 2019