Does your friend have Type 1 or Type 2 diabetes? I didn't know about this previously but did a quick
google DuckDuckGo for you
(eh no honestly I used Google, but you shouldn't)...
There does seem to be an increased risk of hyperglycemia and ketoacidosis, especially in Type 2 diabetics, which can be mitigated supposedly by pretreatment with insulin - but is still good to be aware of.
Diabetes alters the blood glucose response to ketamine in streptozotocin-diabetic rats
However, ketamine dose dependently elevated glucose in diabetic rats from 80 mg/kg to 120 mg/kg at 1 hour after injection. ... Ketamine did not induce acute hyperglycemia any more after diabetic rats pretreated with insulin.
Diabetic Ketoacidosis: the Usual Villain or a Scapegoat?
We describe a case of severe metabolic acidosis in type 1 diabetes far exceeding the accompanying diabetic ketoacidosis (DKA), highlighting pitfalls to management of DKA by protocol alone. ...
Ketamine may cause acidosis and rhabdomyolysis in severe intoxication. Ketamine is a major danger in the “rave” scene (3), compounding the complications of ketoacidosis. Although our patient denied ketamine use, mild rhabdomyolysis was congruent with ketamine toxicity. Drink spiking was possible. Severe metabolic acidosis with ketamine intoxication without rhabdomyolysis is reported (4). Another possibility is urinary bicarbonate loss secondary to ketamine-induced urinary excretion of large amount of β-hydroxybutyrate (5).
There are a few other results but generally parroting the same general advice about "illegal" drug use, these 2 were the relevant scientific ones that stood out to me. Just as an interesting curiosity, I did also find
a site advocating the use of ketamine for diabetic neuropathy, which maybe indicates that in controlled doses it's not
that dangerous, on it's own, in a clinical setting, although that particular site has an obvious ulterior motive in advocating ketamine use for all sorts of conditions so I also wouldn't put too much stock in that particular application of ketamine over other options.
I didn't find anything that interesting really about ketamine and gout although there were also a few sites referencing the use of ketamine for relief of gout related pain, so I would guess this condition isn't hugely relevant.
Benzos in general are very safe physiologically so I didn't bother looking up anything relating to that, I don't think that there is much extra to be concerned about with the 2 conditions you mentioned.
Not that there isn't reason to be concerned - I haven't even mentioned alcohol yet, ohhh man, where to start. Alcohol is a particularly toxic drug in almost all cirumstances, and polydrug combinations are a whole kettle of worms for anyone. I personally think the dangers of ketamine and alcohol use are kind of overblown, but also I am very experienced with both and just as people keep drowning in bathtubs, swimming pools, or flotation tanks on ketamine, it's entirely possible for someone to throw up and drow in their own vomit, as has been mentioned.
Dosage matters though, honestly I think combining 3 "sedatives" (I use the term loosely, ketamine is an atypical sedative of course) on a regular basis is not a good habit to get into both for the acute dangers and for the havoc it will wreak on one's psyche. But, if your friend is just having a few drinks sometimes, doing a liiitle ketamine - as many people do - maybe taking the odd benzo if that's their scene, while still being responsible about it, keeping themselves insulined up, monitoring their blood sugar level, and hanging with responsible people who would be able to administer insulin if needed... or even contact the emergency services in a worst case scenario... then it's possible they know what they're doing and will, in all likelihood be absolutely fine. Although I see you're in Malaysia, in which case contacting the emergency services may have it's own dangers, given the Malaysian government's absolutely horrific, barbaric, amoral, insane and inhuman treatment of drug users.
In fact if your friend is also in Malaysia then the Malaysian government and law enforcement agencies probably pose a far greater danger to their life than any drug ever will, so I would seriously be more concerned about doing absolutely everything you can to protect your friend from
them.
Setting aside my geopolitical gripes though, it's hard to judge the real danger given that, by your own admission, drugs are not your scene and you haven't previously had any interest in them, so try to keep in mind that it's possible your perspective is a little skewed. Is it possible for someone with diabetes and gout to do the 3 drugs you have mentioned simultaneously, and relatively safely? Absolutely yes. Is your friend using them safely? It's impossible to know without a little more information. However as mentioned, ketamine is a little more risky for diabetics, so your friend should be aware of this.
Interestingly, alcohol can cause hypoglycemia, and ketamine can cause hyperglycemia, in diabetics, so maybe co-administration kind of levels out the bad effects in a weird way.
Definitely not to be encourage though even so, that's usually not how biology works. I would imagine in any case that most diabetics are more familiar with alcohol related dangers given that it's the drug of choice for the majority of the modern world. So yeah... to summarise, ketamine can be a bit more hairy with diabetics - primarily Type 1 - but dosage matters with all these substances in assessing their danger.
