Can cannabis help with diabetes? – What do we know, and what guidance should be given to patients with diabetes?
Despite conflicting research, there is evidence supporting cannabis' protective action against diabetes. Read on to learn about the current guidelines from medical organizations.
It is always important to discuss one’s full medical history with your health care provider before beginning any new form of medical treatment or procedure. This allows your doctor to screen for any potential risk factors, complications, or side effects that are commonly linked to certain conditions.
In the case of diabetes, it is currently not common for health care providers specializing in cannabis medicine to screen for diabetes in the way they would commonly screen and/or caution patients regarding risk factors such as a history of schizophrenia or heart disease.
The relationship between cannabis medicine and diabetes is an area still requiring more extensive research. However, there has been some clinical studies on the subject to go along with a significant level of anecdotal evidence. While some of the existing data is contradictory, clinical research has been able to identify a number of potential benefits as well as reasons for diabetic patients to take extra precautions when consuming cannabis medicine products.
Despite the lack of a robust body of research regarding cannabis and diabetes, current anecdotal and clinical evidence suggests that cannabis may have either a positive or neutral effect when consumed by patients with diabetes.
The endocannabinoid system (ECS) plays a role in how the body regulates food intake and body weight. Studies have shown that individuals who consume cannabis have lower rates of obesity than those who have never consumed cannabis, as well as lower rates of diabetes. Research has also shown an association between cannabis consumption and smaller waists circumferences, lower fasting insulin levels, and lower HOMA-IR.
Cannabis medicine that is cannabidiol (CBD) dominant can also potentially help prevent and/or treat arterial inflammation, peripheral neuropathy, diabetic retinopathy, and gastrointestinal pain/cramping.
In jurisdictions where patients have easy access to cannabis and hemp products, it has become common for diabetic patients (relying largely on anecdotal evidence) to self-medicate using cannabinoid medicine for:
- Stabilizing/controlling blood sugar levels
- Increased insulin sensitivity
- Maintaining a healthy body weight
- Neuropathic pain relief
- Nerve inflammation prevention
- Reducing arterial inflammation
- Improved circulation via vasodilation
- Lowering blood pressure
- Muscle cramp relief
- Controlling restless leg syndrome
- Preventing diabetic retinopathy
- Limiting gastrointestinal pain/cramping
- Improved sleep quality
CANNABINOIDS AND DIABETES
Studies suggest that a variety of cannabinoids found in cannabis medicine can potentially offer differing benefits and/or treatment options for patients with type 1 and type 2 diabetes.
- Reduce hyperglycemia and control blood sugar
- Prevent/limit inflammation
- Reduce neuropathic pain
- Decrease oxidative stress
- Limit vascular hyperpermeability
- Increase insulin production
- Reduce cholesterol levels
- Prevent diabetic retinopathy
- Improve insulin production
- Relieve neuropathic pain
- Reduce fasting plasma glucose
- Elevate adiponectin levels
- Reduce fasting plasma glucose
- Increase adiponectin levels
- Increase apolipoprotein A levels
- Improve pancreatic β-cell function
Significantly more clinical research is still needed to properly establish any potential benefits. However, there is enough evidence to suggest the possibility that cannabis medicine could prove to be more effective in managing diabetes than current medication commonly used for treating diabetes.
REASONS TO EXERCISE ADDITIONAL CAUTION
Studies have identified several risk factors regarding cannabis use and diabetes. However, these factors are most commonly associated with the recreational use of cannabis products impairing a patients’ ability for effective self-management. Those consuming a high dosage of THC resulting in feelings of euphoria or being ‘high’, may also experience an impaired ability to consistently make good choices.
This impairment can lead to:
- Inadequate monitoring of blood sugar and ketone levels
- Irregular use of prescribed medications
- Increased appetite
- High caloric intake
- Increased consumption of carbohydrates
- Acute blood pressure increase
- Changes in levels of physical activity
- Decreased triglycerides and high-density lipoprotein cholesterol
- Failure to properly identify symptoms of low blood sugar
This potential for impaired self-management has been shown to double the likelihood of type 1 diabetes patients experiencing diabetic ketoacidosis (DKA). DKA is the result of excess ketone production in the body causing one’s blood to become acidic. Individuals consuming recreational cannabis and/or a regular high dosage of THC dominant cannabis products should discuss the risks of DKA with their health care provider, and increase the frequency for checking blood sugar and ketone levels.
An additional risk factor for DKA in type 1 diabetes patients is the potential for experiencing cannabinoid hyperemesis syndrome (CHS). While CHS is a rare condition linked to daily long-term consumption of high dose cannabis products, it can cause severe bouts of vomiting resulting in dehydration and increased ketone levels. Failure to properly treat DKA can result in severe dehydration, brain swelling, and even death.
Beyond the potential impacts of impairment on self-management behaviours, research has also indicated a potential increased risk for:
- Myocardial infarction
- Arterial occlusion
- Renal disease
Additionally, the regular consumption of cannabis in young adults is linked to an increased risk of prediabetes later in life, however this is not currently linked to an increased risk of developing diabetes.
Organizations such as Diabetes Canada have prepared some basic guidance based on the evidence available in order to assist doctors, educators, and social safety awareness advocates in their goals of better educating and cautioning those living with diabetes.
For patients with type 2 diabetes who are able to maintain their target glucose levels and who currently practice healthy behaviors (eating right, checking levels/taking medications regularly), the primary concern is to ensure that when using cannabis products, patients are able to continue to practice good behaviors. While there is evidence that cannabis use can help in stabilizing blood sugar levels, recreational use of cannabis has been linked to diabetic patients over eating and forgetting to check their levels and/or take their medications. Thus, it is prudent to caution and educate patients on maintaining healthy habits, even if they are unlikely to experience euphoria or feel ‘high’ when using a proper dosage of a cannabis medicine product.
Diabetes Canada also recommends that recreational cannabis users with type 1 diabetes should be made aware of all potential risk factors and advised to check their blood sugar and ketone levels more frequently than usual.
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Research regarding cannabis and Diabetes:
- The Role of Cannabis and Cannabinoids in Diabetes https://doi.org/10.1177%2F1474651410385860
- Cannabis Use as Risk or Protection for Type 2 Diabetes: A Longitudinal Study of 18 000 Swedish Men and Women https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098083/
- Cannabis Smoking and Diabetes Mellitus: Results from Meta-Analysis with Eight Independent Replication Samples https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801109/
- Efficacy and Safety of Cannabidiol and Tetrahydrocannabivarin on Glycemic and Lipid Parameters in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Pilot Study https://diabetesjournals.org/care/article/39/10/1777/129/Efficacy-and-Safety-of-Cannabidiol-and
- The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults https://doi.org/10.1016/j.amjmed.2013.03.002
- Obesity and Cannabis Use: Results From 2 Representative National Surveys https://doi.org/10.1093/aje/kwr200
- Beneficial effects of a Cannabis sativa extract treatment on diabetes-induced neuropathy and oxidative stress https://hal.archives-ouvertes.fr/hal-00483244
- Randomized Placebo-Controlled Double-Blind Clinical Trial of Cannabis-Based Medicinal Product (Sativex) in Painful Diabetic Neuropathy: Depression is a major confounding factor https://doi.org/10.2337/dc09-1029
- A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment https://doi.org/10.1002/j.1532-2149.2013.00445.x
- Neuroprotective and blood-retinal barrier-preserving effects of cannabidiol in experimental diabetes https://pubmed.ncbi.nlm.nih.gov/16400026/
- Cannabis use does not impact on type 2 diabetes: A two-sample Mendelian randomization study https://doi.org/10.1111/adb.13020
- Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III https://pubmed.ncbi.nlm.nih.gov/22368296/
- The effects of recreational cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: a rapid review https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01411-9
- Cannabis Use Is Associated With Increased Risk for Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Findings From the T1D Exchange Clinic Registry https://doi.org/10.2337/dc19-0365
- An Unusual Cause of Recurrent Diabetic Ketoacidosis in Type 1 Diabetes https://www.amjmed.com/article/S0002-9343(16)30290-X/fulltext
- Marijuana use, diet, body mass index, and cardiovascular risk factors https://doi.org/10.1016/j.amjcard.2006.03.024
- The relationship between cannabis use and diabetes: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III https://pubmed.ncbi.nlm.nih.gov/30288813/
- Marijuana Use and Type 2 Diabetes Mellitus: a Review https://pubmed.ncbi.nlm.nih.gov/27747490/
- Marijuana use and risk of prediabetes and diabetes by middle adulthood: the Coronary Artery Risk Development in Young Adults (CARDIA) study https://pubmed.ncbi.nlm.nih.gov/26364621/
- Cannabis use prevalence among individuals with diabetes: The National Survey on Drug Use and Health, 2005-2018 https://pubmed.ncbi.nlm.nih.gov/32470752/
- Diabetes Canada Position Statement on Recreational Cannabis Use in Adults and Adolescents With Type 1 and Type 2 Diabetes https://doi.org/10.1016/j.jcjd.2019.05.010
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