Methamphetamine use and the risk of diabetic ketoacidosis

Methamphetamine use in homicide victims

Methamphetamine use is increasing in the Australian population. It has a known association with violent and erratic behaviour and with an increased risk of unnatural deaths. To determine whether victims of homicide have significant exposure to methamphetamine 100 randomly selected de-identified homicide cases from 2012 to 2021 were accessed from the Forensic Science SA (FSSA) Pathology Database to determine the type of homicide and whether methamphetamine was detected in the blood. A total of 76 males and 24 females were found (M:F = 3:1). Of these, 30 victims (30%) had methamphetamine detected in blood, consisting of 26 males and 4 females (M:F = 6:1; male age range 18-53 years, average 36.8 years; female age range 28-63 years average 44.8 years). Levels of methamphetamine ranged from 0.02 to 3.3 mg/L with an average of 0.64 mg/L, with the highest numbers of positive cases occurring in victims of gunshot wounds (45.5%), and the lowest in those with lethal blunt force trauma (23.5%). This study has demonstrated that victims of homicide in an Australian population are more likely to have used methamphetamine than members of the general population. The reasons for this remain unclear although involvement in a drug selling environment may be an important determinant.

Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies

Access to human pancreas samples from organ donors has greatly advanced our understanding of type 1 diabetes pathogenesis; however, previous studies have shown that donors have a high rate of substance use, and its impact on pancreatic histopathology in this disease is not well described. One-hundred-thirty-one type 1 diabetes and 111 control organ donor pancreata from persons 12-89 years of age (mean 29.8 ± 15.5 years) within the Network for Pancreatic Organ donors with Diabetes (nPOD) were examined for insulin positivity, insulitis, amyloid staining, acute and chronic pancreatitis, and chronic exocrine changes (acinar atrophy, fibrosis, fatty infiltration, or periductal fibrosis); findings were compared by history of substance use. A secondary analysis compared exocrine pancreatic histopathologic findings in type 1 diabetes versus control organ donors regardless of substance use history. We observed a high but congruent rate of substance use in type 1 diabetes and control organ donors (66.4% and 64% respectively). Among donors with type 1 diabetes (but not controls), islet amyloid (OR 9.96 [1.22, 81.29]) and acute pancreatitis (OR 3.2 [1.06, 9.63]) were more common in alcohol users while chronic exocrine changes (OR 8.86 [1.13, 69.31]) were more common in cocaine users. Substance use impacted the pancreata of donors with type 1 diabetes more than controls. Overall, despite similar rates of substance use, acute pancreatitis (15.3% versus 4.5%, p=0.0061), chronic pancreatitis (29.8% versus 9.9%, p=0.0001), and chronic exocrine changes (73.3% versus 36.9%, p<0.0001) were more common in type 1 diabetes donors than controls. Alcohol and/or cocaine use in type 1 diabetes organ donors increases exocrine pancreas pathology and islet amyloid deposition but does not affect insulitis or insulin positivity. Exocrine pathology in type 1 diabetes donors is common, and further study of the pathophysiology of these changes is needed.