Medical views and public opinions on cannabis (marijuana) have come a long way in the last several decades. Today, medicinal and recreational use of the plant and its derivatives are quickly gaining both acceptance and popularity.

What does this mean for people with diabetes who may use the plant or its constituents (where it is medically or recreationally legal)?

This article summarizes the major effects of cannabis and the derived compounds on physiology and various health conditions, particularly as they may relate to people with diabetes. However, cannabis and many of the associated products remain illegal at the federal level. Anything written in this article is for informational purposes only and is not intended to serve as medical advice.

Marijuana Laws in the United States

According to The National Organization for the Reform of Marijuana Laws (NORML), thirteen states have decriminalized marijuana use, a whopping thirty-two states have enacted medical marijuana laws, and ten states have fully legalized recreational marijuana use for adults.

Image credit: NORML

Medicinal Uses of Cannabis

It is well-established that there are numerous medicinal properties of cannabis. Reports of medicinal cannabis use date back thousands of years, and more and more studies are being conducted today, with increased tolerance, legal status at the local level, and more widely-accepted view of the potential health benefits.

How does it work? Briefly, our bodies have what is referred to as an endocannabinoid system—that is, the specific cellular receptors that can interact with several different compounds that are found in marijuana and can affect a variety of physiological processes. As can be seen in the diagrams below, these receptors are present in a variety of organs and tissues in humans.

 

Cannabis contains many different compounds. The two major active compounds are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Researchers note that “available research indicates that the main two compounds, d-9-THC and CBD, whilst having similar effects in certain domains, also have almost opposite effects to one another in other aspects.” This highlights why specific preparations (e.g., CBD only) may be especially useful for treating a particular health condition.

Which health conditions may benefit from the use of cannabis or its derivatives? Since the endocannabinoid system can affect numerous processes, there are many conditions that can be targeted.

Some major conditions that have been proposed for targeting include:

• Anorexia
• Autoimmune Diseases (Rheumatoid Arthritis, Multiple Sclerosis, Inflammatory Bowel Disease)
• Cancers
• Cardiovascular Disease
• Glaucoma
• Liver Disease
• Nausea
• Nephropathy
• Neurodegenerative Diseases (e.g., Parkinson’s, Alzheimer;’s, Huntington’s)
• Obesity
• Pain
• Psychiatric Disorders

So, marijuana can affect a variety of organs and exerts both physical and psychological effects.

Many of these uses are already approved in some or all states where medicinal marijuana is legal. As can be seen, some of these conditions (e.g., nephropathy, cardiovascular disease, obesity) are more prevalent in people with diabetes, which may make medicinal cannabis use more likely in this population. In fact, at least one study reported on the benefits of CBD for the treatment of diabetic cardiomyopathy, while other research has shown that the endocannabinoid system is intimately involved in the development of many diabetes-associated complications, and highlights that several clinical trials have recently explored targeting cannabinoid receptors for treatment.

Marijuana and Blood Glucose Management

The use of cannabis or its preparations can offer treatment for various health conditions, including ones that are more prevalent in the diabetes population. So, can the compounds affect blood glucose control and what should individuals with diabetes take into consideration to stay safe? 

Potential Effects on Blood Glucose Levels

Interestingly, some research has suggested that marijuana users tend to be thinner than non-users and that users may be less likely to develop diabetes. Another study suggested that “chronic cannabis smoking was associated with visceral adiposity and adipose tissue insulin resistance but not with hepatic steatosis, insulin insensitivity, impaired pancreatic β-cell function, or glucose intolerance.”

When it comes to the overall effects of marijuana or its components on blood glucose levels at any specific time of use, no conclusive research is available. Many variables affect blood glucose levels and can include food consumption, medication use, activity, anxiety levels, etc. This means that it’s very important for the individual to self-monitor their blood glucose levels to stay safe.

What to Look Out For

Of course, any person with diabetes should always be on the lookout for hypoglycemia and hyperglycemia and make the appropriate adjustments. Marijuana can affect one’s mental state, so it is important to prepare ahead of time, by setting alarms to check blood glucose levels, or by having another individual with you, who knows about diabetes and can help you check your blood glucose and make the appropriate treatment decisions, if necessary.

Interestingly, a recent study suggested an association between marijuana use and a higher likelihood of developing diabetic ketoacidosis (DKA), a serious and life-threatening complication of diabetes. However, a causal relationship is not clear, the findings are limited by small sample size, and confounding variables, such as income and education level. Patients who used marijuana also happened to have a significantly higher A1c level. It could be that in this case, the cannabis-using population was generally less diligent in their diabetes care for various reasons.

Conclusions

As with using any new medication or recreation drug (such as alcohol), it is imperative that people with diabetes remain in control of their condition by checking their blood glucose levels frequently and adjusting accordingly. If a patient is prescribed medicinal cannabis, it is important to discuss any concerns with a healthcare provider ahead of time and to be extra diligent about checking blood glucose levels frequently during use.

Today, cannabis remains illegal at the federal level, but a gray area is increasingly emerging, for both medicinal and recreational use, as more and more states pass new legislature. We will update this article as more research is conducted, and as state and federal laws are updated.

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