Introduction Insulin is used among image and performance enhancing drug (IPED) communities for its anabolic effects, but its use carries significant risks, with the acute danger being hypoglycaemia, which can be life-threatening if not properly managed. Within these communities, harm reduction practices and informal peer knowledge exchange play a critical role in the way substances are consumed. This qualitative study sought to understand these community practices regarding non-medical insulin use among people who use IPEDs.

Method Semi-structured interviews were conducted with people who use IPEDs, and specifically, insulin. Participants were asked about their risk practices, harm reduction strategies, and the community dynamics that shape their use of insulin. Our analysis centred on how social and material networks of peers, technologies, and information flows contribute to the social production and protection of risk.

Results The study involved an international cohort of 14 participants (13 men, 1 woman, aged 25-45, M = 33.34) who used insulin for non-medical purposes. The analysis revealed two themes: Intersecting Risks, which encompassed the physical, psychosocial, and self-imposed risks associated with insulin use, and Social Protection of Risks, focusing on community-driven harm reduction strategies. People who use insulin actively construct risk through community-driven knowledge and informal education. Social protection is facilitated through peer networks, where harm reduction strategies are shared.

Discussion This research underscores the importance of community-care in harm reduction and challenges individualised models of risk management. It highlights the need for community-centred health interventions that recognise the relational dynamics of risk management among IPED-using communities.