Over a decade ago, we published a brief article here at DiabetesMine about how cannabis (yep: pot, grass, weed, ganja) can be used to treat diabetes, and people have been flocking here ever since to learn more.
Now that it’s (mostly) legal, we’ve taken a broad look at the topic and growing body of research (OK, much of it in animals) showing that cannabis can have a number of positive effects on diabetes.
One of the first big reports ever published by the American Alliance for Medical Cannabis (AAMC) purported that cannabis can have the following benefits for PWDs (people with diabetes):
- stabilizing blood sugars (confirmed via “a large body of
anecdotal evidence building among diabetes sufferers”) - anti-inflammatory action that may help quell some of the
arterial inflammation common in diabetes - “neuroprotective” effects that help thwart
inflammation of nerves and reduce the pain of neuropathy by activating
receptors in the body and brain - “anti-spasmodic agents” help relieve muscle cramps and
the pain of gastrointestinal (GI) disorders - acts as a “vasodilator” to help keep blood vessels
open and improve circulation - contributes to lower blood pressure over time, which is vital
for diabetics - substituting cannabis butter and oil in foods “benefits
cardiac and arterial health in general” - it can also be used to make topical creams to relieve
neuropathic pain and tingling in hands and feet - helps calm diabetic “restless leg syndrome” (RLS), so
the patient can sleep better: “it is recommended that patients use a
vaporizer or smoked cannabis to aid in falling asleep”
Evidence for all of this still stands, and has in fact been corroborated and built upon in the past decade.
While there’s some conflicting evidence on marijuana’s role in delaying the risk of developing type 2 diabetes, research shows it is beneficial indeed for those already diagnosed with either type 1 or 2, and especially for those who suffer complications.
A milestone study published in the American Journal of Medicine in 2013 concluded:
- cannabis compounds may help control blood sugar
- marijuana users are less likely to be obese, and have lower body
mass index (BMI) measurements — despite the fact that they seemed to take in
more calories - pot smokers also had higher levels of “good
cholesterol” and smaller waistlines
“The most important finding is that current users of marijuana appeared to have better carbohydrate metabolism than non-users. Their fasting insulin levels were lower, and they appeared to be less resistant to the insulin produced by their body to maintain a normal blood-sugar level,” Murray Mittleman, associate professor of medicine at Harvard Medical School and the lead researcher told TIME magazine.
In 2014, a “summary of the promising epidemiological evidence” on marijuana in the management of diabetes published in the Natural Medicine Journal also concluded that in thousands of subjects, past and current marijuana use was associated with lower levels of fasting insulin, blood glucose, insulin resistance, BMI, and waist circumference.
And in 2015, Israeli researchers at the Hebrew University of Jerusalem released a study showing that the anti-inflammatory properties of cannabidiol (CBD), a compound found in cannabis, could effectively be used to treat different illnesses including type 2 diabetes.
There’s also compelling scientific evidence that cannabis can aid in treating diabetes complications, for example eye disease; cannabis reduces the intraocular pressure (fluid pressure in the eye) considerably in people with glaucoma, which is caused by conditions that severely restrict blood flow to the eye, like diabetic retinopathy.
Pretty powerful stuff!
When most illicit substances are frowned upon, why is there so much talk about marijuana as medicine, that can actually be good for you?
The linchpin seems to be something called the endogenous cannabinoid system, named after the plant that led to its discovery, which is “perhaps the most important physiologic system involved in establishing and maintaining human health,” according to NORML, the National Organization for the Reform of Marijuana Laws, based in Washington DC.
They explain: “Endocannabinoids and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells. In each tissue, the cannabinoid system performs different tasks, but the goal is always the same: homeostasis, the maintenance of a stable internal environment despite fluctuations in the external environment… Cannabinoids promote homeostasis at every level of biological life, from the sub-cellular, to the organism, and perhaps to the community and beyond.”
Therefore NORML and other marijuana advocates and supporters “believe that small, regular doses of cannabis might act as a tonic to our most central physiologic healing system.”
So let’s say you were using marijuana, or wanted to try it. What would the effect be on your diabetes?
A number of PWDs report that with regular use, they see lower blood sugar levels and reduced A1c results over time. The existing scientific evidence shows that marijuana has an effect on improving insulin resistance — helpful for people type 2 diabetes, but generally not for type 1s. For them, there’s little more than anecdotal evidence to go on.
However, as mentioned, there is a whole body of evidence showing that marijuana is effective in treating eye disorders, chronic pain, sleep disorders, and a number of other ailments often associated with diabetes. So if you are living with one or more complications of diabetes, marijuana may very well ease your pain or slow the progression of the disorder you’re living with.
The area of mental health is a big one for marijuana, as it has been shown to effectively treat everything from clinical depression to post-traumatic stress disorder. Why is this? One answer may come from a study published in February 2015, showing that marijuana use in animals helped restore brain levels of endocannabinoids — which affect emotion and behavior, and have been linked to reduced feelings of pain and anxiety, and increased feelings of well-being.
Of course, some people with depression will not do well on marijuana, as it can also increase feelings of anxiety and paranoia in some people.
The biggest risk of marijuana use with diabetes is probably hypoglycemia; there are a lot of concerns that PWDs’ glucose levels will drop, unnoticed by the patient until they are in dangerous territory.
So in other words: marijuana *could* help you reduce blood glucose levels, feel better, more relaxed and pain-free, but you also need to be careful.
The only consensus among the Medical Establishment on this seems to be that “more research is needed.”
Well, that depends.
Recreational use of marijuana is still a crime most everywhere in the United States, with the exception of Alaska, Colorado, Oregon, Washington and the District of Columbia (DC).
However, medical use of marijuana is gaining acceptance fast. As of this writing, it is now legal in 23 states and DC.
The American Alliance for Medical Cannabis website offers a great overview of the particular laws in each state.
For example in the state of California, with a medical clearance, it is now legal to have up to 8 ounces of dried marijuana and 6 mature or 12 immature marijuana plants in your possession – wow!
So how do you get a medical marijuana card that allows you legal access to medicinal cannabis? There are generally three basic requirements:
- proof of residence of the state or territory in which it is legal
- an eligible “serious medical condition” — definitions
differ by state (California for example adheres to the Americans with
Disabilities Act of 1990 that calls out any chronic condition “that either
substantially limits a person’s ability to conduct one or more major life
activities” and specifically lists diabetes. Elsewhere, eligible
conditions include complications of diabetes like eye disease or chronic pain
from neuropathy) - clearance from a doctor willing to prescribe it to you
Anecdotally, we know that in the San Francisco Bay Area, it’s fairly easy to find a physician willing to sign the papers and send you to a local dispensary to choose your favorite variety of Mary Jane. There are also now delivery services in many states, where a truck pulls up in front of your house, just like the pizza man.
As marijuana is becoming increasingly legal and socially acceptable, so are its related hemp byproducts. CBD oil in particular is getting a lot of attention as a health aide. But should you use it if you have diabetes?
What is CBD Oil and How Is It Used?
Cannabidiol, better known as CBD oil, is made by extracting the essence from the cannabis plant, and diluting it with a “carrier oil” like coconut or hemp seed oil.
It is credited with alleviating symptoms of a number of ailments, including chronic pain, anxiety and depression.
The pure oil form is typically taken by placing the desired quantity of drops under your tongue using the dropper and holding it there for a minimum of 60 seconds — to allow for absorption via the blood vessels under the tongue. Once 60 seconds has passed, you swallow the CBD oil.
How much to take depends on the illness you’re hoping to treat, but generally runs between 2.5-20mg per day.
Is CBD Oil Good for Diabetes?
Emily Kyle, a Registered Dietitian and experienced Holistic Cannabis Practitioner in upstate New York, tells us that just like with any other over-the-counter supplement or medication, there are obvious concerns when using CBD oil if you have type 1, type 2, or gestational diabetes. Those concerns can range from the type and quality of the product being used to various potential side effects.
The biggest concern lies in the possibility of a cannabinoid-drug interaction for those who are taking prescribed medication and/or insulin to manage their diabetes.
Unfortunately, clinical studies in humans on the direct effect of CBD oil on blood sugar is lacking, likely due to the illegal status of marijuana, which is currently seen as a
“What we do know is that the endocannabinoid system plays an important role in how the body responds to insulin, increasing or decreasing insulin sensitivity. This is critically important for those who are taking insulin because it could mean that their blood sugars could rise or fall unexpectedly, making tight control more difficult to achieve,” she says.
“Anecdotally, I have had clients who exhibit completely different response reactions to CBD oil use. One client told me it dramatically decreased their blood sugar within a matter of minutes, which is potentially very dangerous. Other clients notice no effect on blood sugar at all. This is attributed to the uniqueness of each person’s endocannabinoid system and their personal endocannabinoid tone.”
To learn more, including Kyle’s recommendation for the best CBD oil to choose if you have diabetes, see the full story here: Ten Questions Answered on CBD Oil and Diabetes.
FIELDING QUESTIONS
Endocrinologist and Type 1 patient herself Shara Bialo in Rhode Island tells us that as a pediatric endocrinologist, she primarily gets questions from the teenagers she treats:
They all ask the same thing: “I heard that marijuana can be good for lowering blood sugar. Is that true?”
I have to handle this question carefully, so I start by reminding them that marijuana is not legal where I practice. But I also explain that it has been shown to improve insulin resistance, meaning it is likely to be more helpful in type 2 diabetes.
There are also no studies of this nature conducted on minors. I also then bring up the other problems — that getting high can cause the “munchies” (and usually not for low-carb foods!) and that the fuzzy mental state can lead to inaccurate insulin dosing calculations or forgotten doses altogether.
I then wrap up with the suggestion that there is not enough data to prove that marijuana is more safe than harmful, at least as far as diabetes is concerned. Most are okay with this answer, if not a little disappointed ;).
CAUTIONARY NOTES
Certified Diabetes Educator (CDE), Author and Type 1 patient himself Gary Scheiner in Pennsylvania says he offers these words of caution to his patients:
The latest stats show that nearly 30% of people with diabetes age 16-30 have at least tried marijuana, so it is a common concern. While it does not have the strong link with cancer than tobacco has, it can have detrimental effects on cognitive function and can affect diabetes control adversely by:
- Impairing judgement (resulting in inaccurate insulin dosing,
for example) - Increasing appetite and leading to binge eating
- Contamination (marijuana is not regulated) with impurities such
as lead can contribute to early-onset kidney disease
OPEN COMMUNICATION
Susan Weiner, named Diabetes Educator of the Year in 2015, who’s also known for her books and columns on diabetes care, tells us that most healthcare professionals shy away from even discussing this topic, but they really shouldn’t:
Most health care providers are “skeptical” and “cautious” and probably a bit nervous about recommending marijuana use for people with diabetes. Although there are some encouraging studies about the benefits of marijuana use insulin levels, weight management, lowering blood pressure (and a number of other possible benefits) the research is conflicting. More properly conducted studies and evidence based research is needed before cannabis can be recommended for most people with diabetes. We also have to determine if additional conditions such as heart disease would rule out using marijuana as part of the diabetes treatment plan. In addition to the these concerns, determining proper dosage remains problematic.
Over the years very few of my patients have talked about marijuana use as it relates to their diabetes care. However, many have told me they use marijuana recreationally… I think it’s imperative to have a very open dialogue with my patients about everything related to their health and diabetes management.
I’m actually concerned if my patient is uncomfortable discussing this or any other topic with their endocrinologist or primary care provider. I always tell my patients that they are the leader of their own healthcare team, so their concerns and suggestions are key.
To ignore the topic is doing a disservice to the patient, if it is something they would like to discuss. In order to approach sensitive topics (for example: marijuana use, sexual dysfunction or health literacy issues) I ask open-ended questions, use motivational interviewing techniques and actively listen to what the patient is saying. Although we providers often want to educate and impart as much knowledge as possible to our patients, it’s more important to listen to what’s important to them.
USE RESPONSIBLY
Dr. Korey Hood, Professor of Pediatrics, Psychiatry and Behavioral Sciences at Stanford University School of Medicine, explains:
While I am part of the Medical Establishment as a PhD clinical researcher and licensed psychologist, I do not prescribe or administer medical care. But I am very involved in multidisciplinary care of people with diabetes as well as research on prevention and treatment. I perceive the general attitude of diabetes care providers about marijuana use in people with diabetes is that they should not use it recreationally.
From my experience, the group of patients most likely to ask about it are teenagers and young adults. My approach is to follow these guidelines: a) it is generally best to start discussing substance use with pre-teens (whether defined by chronologic age of around 12 or developmental level if more mature than most other 11-year-olds, for example), b) it is better to provide information and education aimed at prevention than a “just say no” approach, which does not work, and c) always review the legal guidelines depending on the state I practice in (currently California). I very much support an effort to discuss early and often and provide factual information.
I always attempt to have open and honest discussions about marijuana use (and other substances, particularly alcohol). I typically review the following, often in this order:
- It’s important to know the laws in your state. Most states have
not legalized recreational use while a number have medical marijuana laws.
Decriminalization shouldn’t be confused with legalization. If I am talking to
youth under 18, I usually emphasize this point more than I would with older
adults. - But if planning to use, best to do it as responsibly as possible.
“Responsible” use means moderation and attempting to avoid use until the brain
is fully developed (around age 25). I always mention there are studies that show
even recreational use can have negative effects on brain activity and moods.
These effects are worse for daily users. There are also data, mostly in studies
of men, to note the negative effects on fertility. I try to review what we
know (and don’t know) so that any use is engaged in with eyes wide open. - From a diabetes perspective, I usually focus on the indirect
effects of marijuana use. While I am not aware of laboratory data on direct
effects of THC(the main psychoactive ingredient in cannabis) on
blood glucose levels, I focus on the indirect effects of getting the “munchies”
and typically not making good decisions regarding insulin or other medications
after marijuana use. The typical scenario reported to me is that there is
overeating and blood sugars end up high. Occasionally there is an over-bolus
but that seems to be less common. - I also talk about ways to ingest marijuana and that there are more
dangers associated with smoking, versus eating, versus using vaporizers.
Smoking tobacco/cigarettes is one of those areas that I plead with people with
diabetes (and those without as well) to not ever do. Smoking marijuana can have
negative effects as well. I don’t recommend a way to do it but do discourage
smoking in any form. - Finally, I always mention that “responsible” use means not driving
after any use, having someone around you who knows you have diabetes and is not
under the influence, and making sure someone around you knows how to treat
extreme lows or highs if necessary.
C.W., a 36-year-old man in California, shares:
I was diagnosed with type 1 diabetes in my freshman year of college (at 18 years old, 18 years ago). I used marijuana recreationally throughout college and for about six years thereafter, during which I became aware of some of the research as to cannabinoids and their effects on the progression of complications from diabetes (specifically
I ceased my use of marijuana for a number of years in my late 20s and early 30s, and noticed during that time that my diabetes control deteriorated noticeably — more hypoglycemic and hyperglycemic events, and my A1cs went from the mid-7s to the mid-8s. I also began to develop early signs of Diabetic Nephropathy.
I’ve only recently (for the last 8 months or so) resumed my marijuana use, this time at the advice of a doctor, and with an official recommendation.
My kidney function has improved, and so has my control over blood sugars. I attribute this to a number of factors, including a reduction in anxiety over blood glucose numbers which led to over-corrections in both directions, improvements in blood pressure (probably at least partly due to the reduced anxiety), and the hypothesized effects of CBD from the marijuana reducing oxidative stress on my nervous and circulatory systems.
My A1c has improved significantly — my last one was 7.3%, and assuming my meter/CGM readings are accurate, the next one should be in the mid-6s.
In terms of risks, the major concern voiced by my doctor was a potential lack of ability to feel oncoming hypoglycemia. Not really an issue for me, personally, as I have a CGM, and I put effort into staying aware of any effects that I might misconstrue.
I should also note that even for recreational users, the potential for causing hypoglycemia is a lot less with marijuana than with alcohol, since pot does not have the same suppressive effect on hepatic gluconeogenesis (metabolic processing of glucose) that alcohol does. One other thing (not mentioned by the doctor, but I keep an eye on) is the “munchies” that some strains of marijuana can cause. I don’t want to go on a carb binge, so I keep low- or no-carb snacks around in the event of this, although the CBD-heavy strains that I usually use don’t cause the munchies the same way that THC-heavy strains of marijuana do.
I’m sure pot isn’t for everyone, as almost nothing is cut-and-dried when dealing with medical issues, and potential side effects can be difficult to predict. Some people may have other conditions which would contraindicate marijuana use.
However, for people who live in places with a Medical Marijuana program (or, in the case of CO and WA, legalized recreational use for everyone), it may be worth considering as an adjunct to their management regimen. Also, given that a large number of PWDs also suffer from other comorbid autoimmune conditions for which marijuana may be indicated as a treatment, it’s worth noting that taking it for something else may as a side effect help them to improve their D-management.
A.C., a 40-year-old woman with T1D in the Midwest, shares:
I marked my 32nd dia-versary in January 2016. I use shots only at this time — no pump or CGM.
I experimented with marijuana in college and use it recreationally as an adult. It’s not a regular part of my life, but I enjoy it when in a safe, controlled environment.
Effects are tricky to describe because there are multiple layers depending on the type of marijuana used. Tincture (liquid extract) is more of a body high (makes you relaxed) — but you can totally function. Edibles have the same effect, and smoking seems to be more of the “head high.”
The smoking component makes me process my thoughts differently, kind of giving me the ability to think freely. All of these factors are dependent on my environment (who am I with, are we brainstorming new ideas or just trying to relax). It doesn’t make me particularly hungry, but when it does, I eat healthy snacks (handful of cashews, hummus and carrots or fresh fruit).
I’ve noticed on multiple occasions that pot lowers my blood sugar — not dramatically where I’ve had an emergency but just overall lower numbers. In fact, I mentioned a particular episode with my dietitian when I changed from NPH & Regular to Lantus and Novolog. He too, happened to be a T1D and said it had the same effect. He also mentioned purchasing certain kinds of pot because he knew it had that effect on him.
The dietitian conversation was sort of spontaneous; I’ve never discussed this outright with my doctor or CDE because it’s illegal in the state of Oklahoma.
I would gladly sign up for a clinical trial on marijuana use and diabetes should one exist. But experts tell me the cost of research trials with “illicit” drugs is far too steep because of all the liability issues.