Cannabis for Diabetes – is it safe?
Several exciting recent studies show that cannabis reduces risk of diabetes, and metabolic syndrome, reducing BMI and obesity. In patients with diabetes type 2 (T2D) it improves insulin resistance, and lowers fasting insulin levels, even reducing waist circumference. (2,3,4) It is counter-intuitive to learn that cannabis, which we associate with increased appetite, can have such a stunning ability to reduce risk of diabetes. (6) However, this is what the studies show again and again often to the confusion of the researchers themselves.
With surprising studies like these one might expect a lot more funding for research that helps clinicians prescribe cannabis to improve diabetes and metabolic syndrome considering it is an epidemic in modern healthcare. While the studies are encouraging, especially for metabolic syndrome, obesity and type 2 diabetes (T2D), we need to be cautious about our recommendations to our patients.
A recent study published by JAMA International, funded in part by Sanfo US, and Dexcom Inc, entitled, Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes, showed that recreationally smoked cannabis doubled the risk of hospitalization for diabetic ketoacidosis (DKA), a serious complication especially for persons with diabetes type 1 (T1D). (1)
This self-reporting designed study involved 450 participants to determine if cannabis users were more at risk for DKA hospitalization than non-cannabis users. Of the 450 participants 134 persons (who were about 30 years of age) 97 reported primarily smoking cannabis for recreational use. Fifty-four respondents took cannabis 4 or more times per week and 48 took it once or less per month. Sixty-one persons used continuous glucose monitoring and 68 used an insulin pump which implies they were educated in diabetes care.
Twenty-eight of the 134 cannabis users had a DKA hospitalization in the preceding 12 months as did 26 of the 316 non-cannabis users. This suggests that cannabis use, especially smoking cannabis primarily for recreational purposes, increases risk of DKA hospitalization. The study doesn’t state whether it was THC or CBD but one would probably conclude that if 97 respondents smoked cannabis and 101 did so for recreational purposes it’s likely they were expecting to get a euphoric or relaxing benefit that comes with a THC dominant variety.
The researchers of the study didn’t discuss why cannabis may have such a powerful effect on persons with T1D but suggested that cannabinoids can alter gut-motility due to hyperemesis, an unusual syndrome due to chronic cannabis overuse that causes a person to become physically ill, vomiting continuously, sometimes for several hours. (7,8) Although the study didn’t determine if any of the respondents had experienced hyperemesis syndrome in relation to the DKA hospitalization.
On the other hand, one might wonder if cannabis is used medicinally, under the guidance of an educated physician, instead of recreationally, there might be a benefit for persons living with diabetes? While it is reasonable to conclude that persons living with T1D shouldn’t smoke cannabis for recreational purposes we still need further studies to learn how and why cannabis has such a remarkable ability to reduce risk of diabetes and improve metabolic markers such as obesity in humans.
A study published in the Journal of Medicine showed that past and current cannabis use were associated with lower levels of glucose, fasting insulin, insulin resistance, BMI, and hemoglobin A1c. And despite cannabis being associated with increased caloric intake and appetite cannabis use resulted in a lower prevalence of diabetes and BMI. (2,10)
References:
- Halis K, Akturk HK, Taylor DD, Camsari UM, Rewers A, Kinney GL, Shah VN. Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes. JAMA Intern Med.2019 Jan 1;179(1):115-118.
- Penner EA, Buettner H, Mittleman MA. The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. The American Journal of Medicine. 2013 July 126(7).
- Yankey BN, Strasser S, Okosun IS. A cross-sectional analysis of the association between marijuana and cigarette smoking with metabolic syndrome among adults in the United States. Diabetes Metab Syndr. 2016;10(2 Suppl 1):S89–95.
- Vidot DC, Prado G, Hlaing WM, Florez HJ, Arheart KL, Messiah SE. Metabolic Syndrome among marijuana users in the United States: an analysis of National Health and Nutrition Examination Survey data. Am J Med. 2016;129(2):173-179.
- Sidney S. Marijuana use and type 2 diabetes mellitus: a review. Current Diabetes Reports. 2016 Nov 16:117.
- Imtiaz, S, Rehm J. The relationship between cannabis use and diabetes: results from the National Epidemiologic Survey on alcohol and related conditions III. Drug Alcohol. 2018; 37:897– 902.
- Lapoint J, Meyer S, Yu CK, et al. Cannabinoid hyperemesis syndrome: Public health implications and a novel model treatment guideline. Western Journal of Emergency Medicine. 2018;19(2):380–386.
- Kim HS, Anderson JD, Saghafi O, Heard KJ, Monte AA. Cyclic vomiting presentations following marijuana liberalization in Colorado. Academic Emergency Medicine. 2015;22(6):694–699.
- Gallo T, Shah VN. An unusual cause of recurrent diabetic ketoacidosis in type 1 diabetes. Am J Med. 2016;129(8):e139-e140.
- Jadoon KA, Ratcliffe SH, Barrett DA, Thomas EL, Stott C, Bell JD, O’Sullivan SE, Tan GD. 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. Diabetes Care 2016 Oct; 39(10): 1777-1786.