The treatments will contain varying quantities of THC and CBD. Treatments will include pills, capsules and oils but smoking cannabis will not be prescribed.
People who stand to benefit will be children with rare, severe forms of epilepsy, adults with vomiting or nausea caused by chemotherapy, and adults with muscle stiffness caused by multiple sclerosis.
- History of cannabis
- Cannabis and its effect on diabetes
- Insulin benefits
- Cannabis drug class
- Legal status
- Effects of cannabis
- Marijuana users have better blood sugar control
- Marijuana and Diabetes: Treating Diabetes with Cannabis
- Marijuana for Diabetes
- Research on Diabetes and Cannabis
- Why Medical Marijuana?
- How Can Marijuana Help Your Diabetes?
- Is It Legal?
- CBD Oil for Diabetes
- Diabetes and Marijuana: Doctors Say…
- Marijuana and Diabetes: Patients Speak Out
- Marijuana & Diabetes Resources
- Does Marijuana Help Diabetes?
- Can Medical Marijuana Help Treat Type 2 Diabetes?
- Can Cannabis Help Prevent Diabetes?
- Can Cannabis Help Control Diabetes?
- Barriers to More Research
- What Clinicians Are Saying
- Next Steps for Researchers and Clinicians
- Can Cannabis Help Manage Type II Diabetes?
- Marijuana for Diabetic Control
- This New Study Will Test Marijuana’s Effect on Type 2 Diabetes
- How Cannabis May Help Treat Type 2 Diabetes
- Marijuana Use Linked to Prediabetes
History of cannabis
Cannabis has been used by humans for thousands of years, with the earliest record of its use dating back to the 3rd millennium BC.
It is indigenous to Central and South Asia, and is believed to of been used by many ancient civilizations, particularly as a form of medicine or herbal therapy.
Cannabis and its effect on diabetes
There is growing research investigating cannabis use and the effects on diabetes.
Possible benefits of cannabis
A number of animal-based studies and some human studies have highlighted a number of potential health benefits of cannabis for diabetes.
Research by the American Alliance for Medical Cannabis (AAMC) has suggested that cannabis can help:
- Stabilise blood sugars – a large body of anecdotal evidence is building among people with diabetes to support this.
- Suppress some of the arterial inflammation commonly experienced by people with diabetes, which can lead to cardiovascular disease
- Prevent nerve inflammation and ease the pain of neuropathy – the most common complication of diabetes – by stimulating receptors in the body and brain.
- Lower blood pressure over time, which can help reduce the risk of heart disease and other diabetes complications
- Keep blood vessels open and improve circulation.
- Relieve muscle cramps and the pain of gastrointestinal (GI) disorders
- Be used to make topical creams to relieve neuropathic pain and tingling in hands and feet
Cannabis compounds have also been shown to reduce intra-ocular pressure (the fluid pressure within the eye) considerably in people with glaucoma – a type of eye disease that is caused by conditions that severely restrict blood flow to the eye, such as severe diabetic retinopathy
THCV and CBD have been shown to improve metabolism and blood glucose in human and animal models of diabetes.
A 2016 study found that THCV and CBD decreased blood glucose levels and increased insulin production in people with type 2 diabetes, indicating a “new therapeutic agent for glycemic control”.
Previously, tests in mice have shown the compounds boosted metabolism, leading to lower levels of cholesterol in the blood and fat in the liver.
UK-based company GW Pharmaceuticals is currently in the process of developing a cannabis spray called Sativex, a prescription medication used to treat muscle spasms in multiple sclerosis. GW is aiming to utilise the CBD and THCV compounds in the product to help with blood sugar regulation in people with type 2 diabetes.
Meanwhile, a separate 2017 study found that cannabis use was linked with lower insulin resistance in a cohort of people with and without diabetes.
Treatment for inflammation
CBD has long been known to possess anti-inflammatory properties, and because chronic inflammation is known to play a role in the development of insulin resistance and type 2 diabetes, research is investigating its efficacy in reducing inflammation in diabetes.
A 2017 study by the Medical College of Georgia revealed that CBD treatment reduced inflammation in animal models of diabetes, concluding “the nonpsychotropic CBD is a promising candidate for anti-inflammatory and neuroprotective therapeutics”.
In 2015, Israeli researchers at the Hebrew University of Jerusalem reported that the anti-inflammatory properties of CBD, could treat different illnesses such as diabetes , atherosclerosis and cardiovascular disease.
In August 2015, cannabis pills containing only CBD, and not THC, were sold legally in Europe for the first time.
Treatment for peripheral neuropathy
Peripheral neuropathy is another complication reported to be eased by cannabis.
The Medical College of Georgia Study in 2017 also revealed that CBD treatment reduced the severity of diabetic retinopathy in diabetic animal models.
Another study in 2015 saw University of California researchers gave 16 patients with painful diabetic peripheral neuropathy either placebo, or single doses of cannabis, which varied in dose strength.
Tests were first performed on baseline spontaneous pain, evoked pain and cognitive function. The higher the content of THC participants inhaled, the less pain they felt
Treatment for obesity
Furthermore, GW Pharmaceuticals research has revealed that cannabis could be used to treat obesity-related diseases such as type 2 diabetes by increasing the amount of energy the body burns
In December 2014, cannabis was linked to a lower likelihood of obesity, lower BMI and reduced risk of type 2 diabetes in an Inuit population.
Cannabis drug class
Laws regarding the production, possession, use and sale of cannabis came into effect in the early 20th century.
But despite being illegal in most countries, including the UK, its use as a recreational drug is still very common.
In fact it is the most used illicit drug in the world, according to the United Nations, with approximately 22.5 million adults across the globe estimated to use marijuana on a daily basis.
In the UK, cannabis is categorized as a Class B drug under the UK Misuse of Drugs Act.
Individuals caught in possession of marijuana are therefore given more lenient punishment – often confiscation and a ‘cannabis warning’ for small amounts.
Effects of cannabis
Cannabis causes a number of noticeable but mild (in comparison with other recreational drugs) physical and mental effects. These include:
- Increased pulse rate
- Dry mouth
- Increased appetite
- Bloodshot eyes
- Occasional dizzy spells
- Problems with memory, concentration, perception and coordinated movement
Pro-cannabis groups and campaigners often highlight its pain relief benefits and stress the fact that not one cannabis-related death has ever been recorded.
Another study in 2015 saw University of California researchers gave 16 patients with painful diabetic peripheral neuropathy either placebo, or single doses of cannabis, which varied in dose strength.
Tests were first performed on baseline spontaneous pain, evoked pain and cognitive function. The higher the content of THC participants inhaled, the less pain they felt
Negative effects of cannabis
Studies that have investigated this subject suggest that cannabis can have a number of effects on blood glucose control, depending on dosage. These include:
- Memory and concentration-related problems which may affect glycemic control.
- Raised appetite, or ‘munchies’ – a craving for sweet/fatty food, which can subsequently lead to hyperglycemia (abnormally high blood sugar levels)
- Impaired glucose tolerance and hyperglycemia when heavily used.
Experts from Diabetes New Zealand, a national non-profit organization, also claim that cannabis indirectly affects blood glucose levels due to the drugs’ effect on the brain, which they say can lead to users not recognizing symptoms of hypoglycemia (low blood sugar) or confusing such symptoms with the effects of the drug.
THURSDAY, Nov. 8, 2018 (HealthDay News) — People with type 1 diabetes who use marijuana may double their risk of developing a life-threatening complication, a new study suggests.
Called diabetic ketoacidosis (DKA), the condition occurs when there is not enough insulin to break down sugar in the body, so the body burns fat for fuel instead. This triggers a build-up of chemicals known as ketones, which make blood more acidic and can lead to coma or death.
“About 30 percent of our patients are using some form of marijuana, and they should be careful when using,” said study author Dr. Halis Akturk. “They should be aware of the DKA risk, and recognize the symptoms — nausea, vomiting, abdominal pain and confusion.”
Akturk is an assistant professor of medicine and pediatrics at the University of Colorado School of Medicine and Barbara Davis Center for Diabetes in Aurora, Colo.
Colorado is one of nine U.S. states that legally allow recreational use of marijuana.
Type 1 diabetes is an autoimmune disease that develops when the body’s immune system mistakenly attacks the insulin-producing cells in the pancreas. Insulin is a hormone that channels the sugar from foods into the body’s cells to be used as fuel.
People with type 1 diabetes no longer make enough insulin on their own. They must take shots or use an insulin pump to deliver the insulin they need to their bodies. However, getting the dose right is a difficult balancing act.
Too much insulin can cause dangerous low blood sugar levels that make people shaky, confused and irritable, and if not treated, can cause someone to pass out and possibly to die.
But too little insulin can lead to high blood sugar levels. Over years, high blood sugar levels can cause the serious complications associated with diabetes, such as heart and kidney disease, vision problems and amputations. Too little insulin can also lead to DKA in as little as a few hours, according to the American Diabetes Association.
In the new study, the researchers invited adult type 1 diabetes patients at a Colorado hospital to complete a survey on marijuana use. Of 450 survey participants, 134 said they used marijuana.
Marijuana users have better blood sugar control
Marijuana (Cannabis sativa) has been used for centuries to relieve pain, improve mood, and increase appetite. Outlawed in the United States in 1937, its social use continues to increase and public opinion is swinging in favor of the medicinal use of marijuana. There are an estimated 17.4 million current users of marijuana in the United States. Approximately 4.6 million of these users smoke marijuana daily or almost daily. A synthetic form of its active ingredient, tetrahydrocannabinol, commonly known as THC, has already been approved to treat side-effects of chemotherapy, AIDS-induced anorexia, nausea, and other medical conditions. With the recent legalization of recreational marijuana in two states and the legalization of medical marijuana in 19 states and the District of Columbia, physicians will increasingly encounter marijuana use among their patient populations.
A multicenter research team analyzed data obtained during the National Health and Nutrition Survey (NHANES) between 2005 and 2010. They studied data from 4,657 patients who completed a drug use questionnaire. Of these, 579 were current marijuana users, 1,975 had used marijuana in the past but were not current users, and 2,103 had never inhaled or ingested marijuana. Fasting insulin and glucose were measured via blood samples following a nine hour fast, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to evaluate insulin resistance.
Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. Current users had 16% lower fasting insulin levels than participants who reported never having used marijuana in their lifetimes.
Large waist circumference is linked to diabetes risk. In the current study there were also significant associations between marijuana use and smaller waist circumferences.
“Previous epidemiologic studies have found lower prevalence rates of obesity and diabetes mellitus in marijuana users compared to people who have never used marijuana, suggesting a relationship between cannabinoids and peripheral metabolic processes, but ours is the first study to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance,” says lead investigator Murray A. Mittleman, MD, DrPH, of the Cardiovascular Epidemiology Research Unit at the Beth Israel Deaconess Medical Center, Boston.
“It is possible that the inverse association in fasting insulin levels and insulin resistance seen among current marijuana users could be in part due to changes in usage patterns among those with a diagnosis of diabetes (i.e., those with diabetes may have been told to cease smoking). However, after we excluded those subjects with a diagnosis of diabetes mellitus, the associations between marijuana use and insulin levels, HOMA-IR, waist circumference, and HDL-C were similar and remained statistically significant,” states Elizabeth Penner, MD, MPH, an author of the study.
Although people who smoke marijuana have higher average caloric intake levels than non-users, marijuana use has been associated with lower body-mass index (BMI) in two previous surveys. “The mechanisms underlying this paradox have not been determined and the impact of regular marijuana use on insulin resistance and cardiometabolic risk factors remains unknown,” says coauthor Hannah Buettner.
The investigators acknowledge that data on marijuana use were self-reported and may be subject to underestimation or denial of illicit drug use. However, they point out, underestimation of drug use would likely yield results biased toward observing no association.
Editor-in-Chief Joseph S. Alpert, MD, Professor of Medicine at the University of Arizona College of Medicine, Tucson, comments, “These are indeed remarkable observations that are supported, as the authors note, by basic science experiments that came to similar conclusions.
“We desperately need a great deal more basic and clinical research into the short- and long-term effects of marijuana in a variety of clinical settings such as cancer, diabetes, and frailty of the elderly,” continues Alpert.” I would like to call on the NIH and the DEA to collaborate in developing policies to implement solid scientific investigations that would lead to information assisting physicians in the proper use and prescription of THC in its synthetic or herbal form.”
Marijuana and Diabetes: Treating Diabetes with Cannabis
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.
Marijuana for 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.
Research on Diabetes and Cannabis
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!
Why Medical Marijuana?
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.”
How Can Marijuana Help Your Diabetes?
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.”
Is It Legal?
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.
CBD Oil for Diabetes
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 schedule 1 drug in the eyes of the Federal Government, Kyle says.
“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.
Diabetes and Marijuana: Doctors Say…
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 ;).
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
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.
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.
Marijuana and Diabetes: Patients Speak Out
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 Diabetic Retinopathy.)
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.
Marijuana & Diabetes Resources
National directory of medical marijuana dispensaries
“Top 5 Benefits of Cannabis for Diabetes” from Sensi Seeds
Cannabis and Diabetes Facts, from Diabetes UK
Diabetes & Cannabis Research Overview, from NORML
Does Marijuana Help Diabetes?
If you’re wondering does marijuana help diabetes, you’re not alone. There is a lot of current research being done regarding the possible therapeutic and medical benefits of marijuana, and one of the areas of study is marijuana and diabetes.
There are certain components in marijuana that are believed to have health benefits in particular, and these are called cannabinoids. The most widely studied are THC and CBD. THC creates psychoactive effects, while CBD doesn’t.
There have been quite a few studies looking at marijuana and diabetes, and they have shown benefits for people with diabetes who use marijuana.
Marijuana may be helpful for stabilizing blood sugar, lowering blood pressure and decreasing artery inflammation. It may also be helpful to improve circulation and also to reduce neuropathic pain, which is a very common complication of diabetes.
Along with helping treat the symptoms of diabetes, marijuana may also be able to help prevent it according to a few studies, because for some reason obesity tends to be less common among cannabis users.
With type 2 diabetes people aren’t able to properly use insulin, and one study found that people using cannabis had lower levels of insulin resistance, improved production of insulin, and lower fasting blood glucose levels.
Diabetic retinopathy is a condition where people with diabetes lose their sight, and some animal research shows that using CBD may protect against it.
One of the many reasons marijuana and diabetes might have positive links to one another is because cannabis is believed to fight inflammation and inflammation is linked to not only diabetes but most other chronic diseases.
While there seem like there can be some benefits with marijuana and diabetes, it’s important to point out the potential downsides as well.
First and foremost, the use of marijuana is known to increase appetite. It’s such a common side effect that it’s referred to as having the “munchies,” and this may mean that you eat large amounts of carbohydrates and unhealthy foods. This can contribute to weight gain and can cause blood sugar levels to rise too quickly.
There are also potential negative general side effects that can come with the use of marijuana including substance abuse, interactions with medications you may be taking, delayed reaction times, impaired memory and concentration, breathing problems and dizziness. There are also issues with legal status when it comes to the use of marijuana in many states.
With an increasing number of states legalizing marijuana for recreational use, and a large number of states allowing medical marijuana, and last year’s FDA approval of first cannabis-derived prescription drug, it’s not surprise people with diabetes have been asking about marijuana. Can it be used safely by people with diabetes and can it be used as a treatment for diabetes?
There is some research showing positive results for the use of marijuana for the treatment of diabetes. But is really safe for people with diabetes to smoke marijuana?
Marijuana has been proven to be an effective treatment for a variety of health ailments—often with fewer side effects than many of the other drugs that are available today with a prescription or over-the-counter. It comes from the cannabis plant and contains cannabinoids, which are chemicals that work within the Endo-cannabinoid System (ECS) in the human body. These chemicals are naturally found within the body but may be in short supply for people with certain ailments. When a person takes a drug containing cannabinoids, these chemicals collaborate with the receptors of the central nervous system to produce various benefits in the brain and body.
Cannabinoids have different properties that impact the way a person’s body and brain works, including:
- Pain sensation
- Immune system response
- Hormone balance (including insulin)
THC (tetrahydrocannabinol) is the cannabinoid that most people are aware of as the active ingredient in marijuana, which is what gives the plant its psychotropic effects. CBD (cannabidiol) is another highly researched chemical found in marijuana that impacts the health in a variety of ways.
Marijuana and Diabetes
When considering marijuana use in conjunction with diabetes, there’s a lack of controlled trial testing on a large scale. In relation to the treatment of diabetes, some studies note that the anti-inflammatory capabilities of the cannabinoids in marijuana may have therapeutic effects that may help to: stabilize blood sugar, lower blood pressure, prevent nerve inflammation, and improve circulation in diabetics. A study published in The Natural Medicine Journal showed that marijuana use may be associated with lower levels of glucose, fasting insulin, body mass index, waist circumference, and HOMA-IR.
Marijuana Effects and Risks
All of these are positive indicators that using marijuana may have a positive impact people with diabetes. However, many considerations should be made before jumping into the use of marijuana. Marijuana, whether or not you have diabetes, comes with its share of potential side effects.
Effects can vary between individuals, but these are common:
- Altered perception
- Short term memory loss
- Lack of coordination
- Slow reaction times
- Damage to lungs and breathing problems (when smoked)
Since the use of marijuana can impact the appetite and perception, it’s important for people with diabetes who use marijuana to be prepared to address insulin and sugar needs as they occur. As balancing blood sugar can be like walking on a tight rope, it is critical to take into account the extra food that may be eaten in response to getting the “munchies”.
Another consideration is, if the THC in marijuana brings on a state of euphoria, the user may not be as capable of discerning how they feel in terms of blood glucose levels. Perceptions may be skewed, which means blood sugar levels should be checked frequently, even if the person “feels okay”.
Of course, if marijuana is smoked, dangers and risks are certainly prevalent in relationship the impact of the smoke on the respiratory system, especially the lungs. Other options for taking marijuana (that may be less dangerous than smoking it) include oils taken sublingually, vaping the oil, edibles, and applying it to the skin in a lotion, cream, or spray.
Legality and Marijuana
If you live in the US and are hoping to legally take marijuana for your diabetes, then the future could be bright. Currently 33 states and the District of Columbia have made marijuana legal for medical purposes, and 14 more states have made allowances for medical use of marijuana with limited THC content.
That said, marijuana usage technically remains illegal federally. Depending on which state you live in, you may be able to access marijuana easily, but it’s important to remember that you still need to be very careful. It is critical to make health decisions based on the recommendations of your doctor as well as the laws that govern the place where you live. And if you are using marijuana medically, always be sure to get it from an approved dispensary.
CBD: Another Option
While marijuana may hold a great deal of promise in treating diabetes, many people are uncomfortable with the feeling they get of being ‘high’. Other people have legitimate concerns about their ability to use marijuana and function in their jobs and duties. This is where CBD oil comes in as an option.
CBD is extracted from the industrial hemp plant and contains only trace amounts of THC, but still has many of the active benefits that marijuana provides. Plus, it’s legal in all fifty states. The FDA has approved CBD oil as a ‘food supplement’ which means a medical professional can’t prescribe it, but can recommend it. As with any medication, check with your doctor to be sure that CBD is a safe for your particular circumstances.
So the question about whether or not marijuana is safe for people with diabetes? Well, the answer is—it’s complicated. And that’s probably not going to change for some time. Staying connected, watching out for more research, and talking to your doctor is your best bet for moving forward.
Can Medical Marijuana Help Treat Type 2 Diabetes?
Although research on marijuana for medicinal purposes is limited and the Food and Drug Administration (FDA) has not approved the drug as a standard of care, 29 states and Washington, DC, have legalized medical marijuana. That legislation has passed at a time when some research, which has mostly been observational and conducted in animals, links marijuana use to improved symptoms associated with HIV, multiple sclerosis, chronic pain, and mental disorders.
But what do researchers say about using marijuana to help treat or prevent diabetes? Suffice it to say, studies suggest you shouldn’t light up just yet.
Can Cannabis Help Prevent Diabetes?
The marijuana plant contains chemicals called cannabinoids that have a range of effects, including increased appetite and diminished pain and inflammation. That all sounds great, but what’s really going on?
Even though some preliminary research suggests medical marijuana may help improve glucose control and insulin resistance, doctors across the board aren’t quick to recommend marijuana for diabetes prevention. That’s because most of the studies haven’t met the gold standard for medical research: Medical marijuana hasn’t been analyzed in large, randomized, controlled studies in human subjects with type 2 diabetes. Such studies reduce the risk of bias in study authors, and provide the most reliable evidence we have for a cause-and-effect relationship between two factors (in this case, medical marijuana and diabetes) rather than just a correlative link, which observational studies draw.
That said, those observational studies may offer clues about how cannabis may affect diabetes. For example, a study published in July 2013 in The American Journal of Medicine looked at nearly 600 adult men and women currently using marijuana and about 2,000 who had used it in the past; after fasting overnight, they had their blood drawn and were screened for other health factors, such as blood pressure, body mass index (BMI), and waist circumference. Compared with those participants who had never used marijuana, participants who were current users had 16 and 17 percent lower fasting insulin levels and measures of insulin resistance, respectively. They were also more likely to have smaller waistlines.
On the basis of their preliminary findings, the authors noted that specific cannabinoid receptors in the body may help improve insulin sensitivity. They were also interested in the association between using the drug and having a smaller waist circumference. Those who use cannabis eat more calories on average, the authors pointed out, and paradoxically also tend to have lower BMIs. One possible explanation: Previous research had found that when marijuana was given to obese mice, the rodents slimmed down and had better functioning of their beta cells, which produce insulin. And finally, the drug may also influence a protein called adiponectin, which has been linked with improved insulin sensitivity.
Results from the latter animal study seem to support the conclusion of an observational cross-sectional study published in January 2012 in BMJ Open. That research looked at about 11,000 participants of the NHANES III study, which sampled the United States adult population and drew an association between use of cannabis and a 58 percent reduced risk of developing diabetes mellitus (the term includes both type 1 and 2) compared with those who don’t dabble in the drug. Although researchers note that more studies would need to be conducted to prove a causal effect, they theorized that the anti-inflammatory properties of cannabinoids may have led to the improved health outcomes in participants.
A more recent study, published in December 2015 in Diabetologia, found an entirely different association between marijuana use and diabetes risk. In that research, current young adult users were 65 percent more likely to develop prediabetes by middle age versus never-users. Keep in mind that with both these studies, data relied on people reporting their marijuana habits accurately and honestly, which may have skewed the results.
Because the association was murky, a team of Swedish researchers conducted their own research. The study, published in October 2016 in the Journal of Diabetes Research, looked at 18,000 men and women and found no link between using the drug and developing diabetes after adjusting for age between people who used cannabis and abstainers.
Can Cannabis Help Control Diabetes?
While studies investigating marijuana as a diabetes prevention tool have not been conclusive, one study suggests the drug may be used to help relieve diabetes symptoms; researchers note those findings are also preliminary.
The research, which was published in July 2015 in the Journal of Pain, found that patients suffering from a condition called diabetic neuropathy, or painful nerve damage due to chronic high blood sugar, may lessen their discomfort by inhaling marijuana. Cannabinoid receptors located in the nervous system across the spinal cord and brain appear to work on multiple planes to relieve pain, including decreasing the excitability of receptors, reducing transmission of pain signals in the brain, and inhibiting discomfort down the spinal cord.
Although the study was conducted in humans, and was randomized, controlled, and double-blinded, it was small — involving only 16 participants. Plus, one study doesn’t mean marijuana is safe to use for this purpose, says one of its authors, Mark Wallace, MD, the chair of the division of pain medicine at the University of California in San Diego.
Because most studies are observational and those that are randomized and controlled are small, results on the relationship cannabis may have to diabetes aren’t conclusive. That’s why more rigorous, high-quality research in humans is needed.
Barriers to More Research
But before a definitive conclusion is reached, there are several barriers stalling medical marijuana research, says Melanie Elliott, PhD, an instructor in the department of neurosurgery at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, who studies cannabinoids as a therapy for traumatic brain injuries, inflammatory conditions, and pain.
One hurdle is the regulatory steps that researchers have to pass. Marijuana is still considered a Schedule I controlled substance, meaning it has a high potential for abuse and no accepted medical use. Heroin and ecstasy also fall into this category. “Because of this, there are federal and local regulations that are pretty discouraging to researchers,” says Elliott, who adds that university regulations and institutional reviews are also required. “There are many tiers of review, which become time-consuming and cost money for researchers,” she explains.
The supply of cannabis for research is another problem. Medical dispensaries offer a variety of strains all grown to have different properties, as well as different products, like extracts, edibles, oils, and cigarettes. As Elliott points out, the only source of medical cannabis for government-backed research must go through the National Institute on Drug Abuse (NIDA) and come from farms at a single U.S. higher-education institute, the University of Mississippi.
“As researchers, we don’t have the diversity of cannabinoid strains and products that are available to patients from dispensaries,” she says. Some patients may prefer an edible, for instance, but under current law, researchers can’t study edibles in a government-backed study. A study in which people with diabetes smoke marijuana isn’t ideal, because it would likely lead to cardiorespiratory problems, but for research on medical marijuana as a whole, this limitation is problematic. “It’s important to know what you’re getting as a patient,” she notes. She adds that some researchers say a good marijuana placebo is lacking.
In large part as a result of these barriers, studies that show an association — and conflicting studies, at that — are the current mainstay of the research in this field.
What Clinicians Are Saying
Clinicians agree that more data is needed.
“This research is in its infancy. As far as using marijuana medicinally to improve measures of metabolism or diabetes, there are far more unknowns than knowns, and it’s way too early to make a recommendation to use cannabis,” says Troy Donahoo, MD, an associate professor in the division of endocrinology, diabetes, and metabolism at the University of Florida in Gainesville, who has studied the effect of marijuana use following bariatric surgery. Donahoo was previously at the University of Colorado in Denver, where he saw many patients with diabetes and obesity who used cannabis recreationally or medicinally for anxiety, sleep, or pain control.
He notes that one thing clinicians agree on is that strains of marijuana that produce a feeling of highness — many of which are recreational — wouldn’t be advisable for people with diabetes because they tend to increase appetite. For people with diabetes, strict diet and weight management is crucial to help regulate blood sugar levels and increase insulin sensitivity.
What do doctors also know? Behavior changes like a healthy diet and more physical activity, as well as approved medications for weight loss and diabetes, have proven benefits to halt the development and progression of the disease. “We know the risks and benefits to these,” he says. That makes these approaches far more preferable than medical marijuana for physicians to recommend.
Next Steps for Researchers and Clinicians
Although medical marijuana legislation has passed in more states, many traditional physicians who rely on research and official U.S. medical guidelines continue to have, like patients, only a partial picture of the drug.
“Part of the challenge is that many physicians still have a very low understanding of marijuana and its potential benefits, and I think they often overestimate the risks. While I do believe some components of cannabis can have beneficial effects, we don’t have the full picture to recommend it,” Dr. Donahoo says.
Though the research that’s needed is slow in coming, things are looking up, says Elliott. Last summer, NIDA called out to researchers to express their needs in better studying medical marijuana. There’s hope that, in the future, these changes will be made to open up research possibilities.
Until that happens, don’t be afraid to tell your physician if you’re using marijuana in any way. “I believe it’s important to have an open relationship with your provider, so they can get the full picture of your care,” Donahoo says.
For more on how cannabis may play a role in treating type 2 diabetes, check out Diabetes Daily’s article “CBD Oil and Diabetes: What You Need to Know”!
Can Cannabis Help Manage Type II Diabetes?
Type II diabetes is a chronic debilitating disease originating from a combination of lifestyle and genetics that eventually leads to insulin resistance, that is, the desensitization of insulin receptors to react to insulin. The Center for Disease Control has estimated that over 100 million Americans suffer from Type II diabetes or are “pre-diabetic”. While there is no “magic pill” to cure Type II, patients can manage their diabetes with exercise, a healthy diet, and the use of insulin and other medications to control blood sugar levels. Yet with the medical marijuana industry open for business, could there a new therapeutic in the works? Or better yet, a prevention?
Photo Source: .com
Claims for the diabetic-curing properties of marijuana have made their way onto the lists of countless ailments that can be treated, if not cured, by smoking marijuana or using cannabidiol (CBD) oil. These are mainly anecdotal (as with many of the other health claims). But the more pertinent scientific question is: does the endocannabinoid system (ECS) (our innate network of receptors and cannabinoid-like chemical messengers that run throughout our bodies) play a role in regulating blood sugar? If so, can this system be utilized to help those who have lost that ability (i.e. diabetics)?
It turns out that the ECS does regulate energy balance and insulin sensitivity. It is also very important in regulating energy balance and adipose (fat cells) tissue. Circulating levels of the endocannabinoid 2-arachin donoylglycerol (2-AG) have been found to be higher in subjects with increased abdominal adipose tissue and lower insulin sensitivity. It has been posited that this dysregulation in 2-AG levels may contribute to the development of Type II diabetes, at least in cases of obesity. In fact, after bariatric surgery, patients were shown to have lower levels of circulating endocannabinoids and better metabolic homeostasis.
The ECS as a whole has largely become recognized as a regulator of homeostasis, that is, it works to keep various systems, such as metabolic rate, energy expenditure, fat composition and glucose utilization in check, or, in other words, within a healthy, normal range. So if the homeostasis in glucose utilization has gone awry, leading to decreased insulin sensitivity (and then down the line, diabetes), could the ECS be manipulated to bring glucose levels back to normal?
Photo Source: unsplash.com
- studies have shown that greater cannabis use either had no relation or was negatively associated with lower body mass indexes (BMIs) and the development of Type II diabetes. This is a bit perplexing, given what we know about the effects of marijuana on appetite (i.e. “the munchies”). The reason or reasons for this discrepancy are reportedly unknown. However, the clinical literature has shown some efficacy of treatment with CBD and/or another, non-psychoactive phytocannabinoid, Δ(9)-tetrahydrocannabivarin (THCV), decreased measures of diabetic biomarkers (e.g. fasting glucose levels and pancreatic beta-cell function) in patients with Type II diabetes.
So perhaps we can chalk up another therapeutic effect on cannabis (or at least some of its compounds): Type II diabetes management. There were no definitive studies with evidence that phytocannabinoids could reverse or cure diabetes, so we will have to rely on anecdotal “evidence” on its putative diabetes-curing properties. For more information about cannabis and diabetes, see the video below.
Video Source: YouTube.com
Source: endocrineweb.com, Center for Disease Control, National Institutes for Diabetes and Digestive and Kidney Disorders, Diabetes – Perspectives in Drug Therapy, Current Diabetes Reports, Diabetes, Obesity Surgery, Youtube.com, Diabetes Care, Critical Reviews in Eukaryotic Gene Expression
Marijuana for Diabetic Control
SEE RELATED ARTICLE p. 583
In 1937, Franklin D. Roosevelt signed the US Marijuana Tax Act that made it illegal to sell or use this herb. Nevertheless, cannabis continued to be used by a small number of citizens in the United States, including jazz musicians, entertainers, and cognoscenti desiring an altered state of mind.
During the 1960s, cannabis use became a symbol for the youth revolution. It was widely used as a mild euphoric on college campuses and among counterculture youth. I remember well coming to parties in Cambridge, Massachusetts, during that heady era and being offered the choice of an alcoholic beverage or a hand-rolled marijuana cigarette. Since then, social use of this herb has continued at a more moderate pace.
In recent years, a synthetic form of its active ingredient, delta-9-tetrahydrocannabinol (THC) (6aR-trans-6a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H dibenzol(b,djpyran-a-01) has been approved by the Food and Drug Administration and is being prescribed to combat chemotherapy and acquired immunodeficiency syndrome–induced anorexia and nausea. This approved agent is named “dronabinol,” with several trade names, including Marinol (AbbVie Inc, North Chicago, Ill). On occasion, I have prescribed it to stimulate appetite and improve mood in apathetic, anorexic, and frail elderly patients, in whom it seemed to have a positive effect.
As a result of the 1937 law, as well as further criminalizing legislation passed during the Nixon administration, marijuana has become a major source of income for illegal drug smugglers. A major site of illegal drug importation is the United States–Mexico border. Hardly a week goes by here in Arizona without news reports involving seizures of large quantities of cannabis by US Border Patrol and Drug Enforcement Administration agents, who work constantly to impede the flow of this agent into the United States. The Drug Enforcement Administration has at this time spent more than 100 billion dollars trying to stop the flow of illegal drugs, including marijuana, into the United States. Unfortunately, the country continues to be flooded with illegal pharmaceuticals and marijuana courtesy of powerful drug cartels.
In recent years, 19 states and the District of Columbia, following California’s lead in 1996, have passed legislation allowing physicians to prescribe marijuana for patients with severe and difficult to control pain or nausea. Similar legislation is pending approval in other states. Marijuana continues to be widely consumed in the United States. Indeed, I can attest from clinical experience that many patients continue to abuse the use of this herb often alongside more dangerous compounds, such as methamphetamine. Anyone working on the inpatient service of a hospital in the United States today sees a daily stream of patients who admit to marijuana use or who are found to have THC in their “tox screen.”
A 2010 ABC news poll found that 81% of Americans favored medical marijuana use and its decriminalization for this purpose. Many other individuals lobby for repeal of the 1937 law forbidding marijuana sale and use. These citizens argue that marijuana should be regulated, sold, and taxed in a manner similar to tobacco and alcohol products.
Despite the ongoing debate, legislation, and current medical use of cannabis, there is a dearth of scientific, pharmacologic, and clinical studies with this agent. I reviewed more than 2070 articles catalogued by PubMed under the heading of medical marijuana and found little about the effect of THC on the metabolome.2x2Teixeira, D., Pestana, D., Faria, A., Calhau, C., Azevedo, I., and Monteiro, R. Modulation of adipocyte biology by δ(9)-tetrahydrocannabinol. Obesity (Silver Spring). 2010; 18: 2077–2085
Crossref | PubMed | Scopus (19) | Google ScholarSee all References, 3x3Gallant, M., Odei-Addo, F., Frost, C.L., and Levendal, R.A. Biological effects of THC and a lipophilic cannabis extract on normal and insulin resistant 3T3-L1 adipocytes. Phytomedicine. 2009; 16: 942–949
Abstract | Full Text | Full Text PDF | PubMed | Scopus (13) | Google ScholarSee all References However, there is a modest literature on the cardiovascular effects of THC, but the overwhelming number of investigations involved central nervous system effects and potential addiction.4x4Montecucco, F. and Di Marzo, V. At the heart of the matter: the endocannabinoid system in cardiovascular function and dysfunction. Trends Pharmacol Sci. 2012; 33: 331–340
Abstract | Full Text | Full Text PDF | PubMed | Scopus (86) | Google ScholarSee all References
Much of what we know about cannabis comes from folktales and limited clinical observation. It was in this context that I was pleased to receive the submission published in this edition of The American Journal of Medicine, entitled “The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance Among US Adults.”5x5Penner, E.A., Buettner, H., and Middleman, M.A. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Am J Med. 2013; 126: 583–589
Abstract | Full Text | Full Text PDF | PubMed | Scopus (85) | Google ScholarSee all References This epidemiologic study revealed that current marijuana users had significantly lower levels of fasting insulin and were less likely to be insulin resistant. Penner et al5x5Penner, E.A., Buettner, H., and Middleman, M.A. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Am J Med. 2013; 126: 583–589
Abstract | Full Text | Full Text PDF | PubMed | Scopus (85) | Google ScholarSee all References analyzed data obtained during the National Health and Nutrition Survey between 2005 and 2010. They studied data from 4657 patients, of whom 579 were current users of cannabis, 1975 used cannabis in the past but were not current users, and 2103 had never inhaled or ingested marijuana. These patients had fasting insulin and glucose levels measured along with a test for insulin resistance. Remarkably, fasting insulin levels were reduced in current cannabis users but not in former or never users. Two additional observations were that waist circumference was smaller and high-density lipoprotein cholesterol blood levels were higher in current cannabis users. These are indeed remarkable observations that are supported, as the authors note, by basic science experiments that came to similar conclusions.
Is it possible that THC will be commonly prescribed in the future for patients with diabetes or metabolic syndrome alongside antidiabetic oral agents or insulin for improved management of this chronic illness? Only time will answer this question for us. Nevertheless, what is very clear is that we desperately need a great deal more basic and clinical research into the short- and long-term effects of this agent in a variety of clinical settings, such as cancer, diabetes, and frailty of the elderly. I would like to call on the National Institutes of Health and the Drug Enforcement Administration to collaborate in developing policies to implement solid scientific investigations that would lead to information assisting physicians in the proper use and prescription of THC in its synthetic or herbal form.
As always, I welcome comments about this editorial and the article referred to on our blog at http://amjmed.blogspot.com.
This New Study Will Test Marijuana’s Effect on Type 2 Diabetes
A researcher at the University of California, Riverside, has been awarded a three-year grant worth $744,000 from the Tobacco-Related Disease Research Program by the University of California Office of the President. The grant money will fund research into the impact of long-term cannabis use on metabolic diseases, such as type 2 diabetes.
Assistant Professor Nicholas V. DiPatrizio of the UCR School of Medicine and his laboratory research team are the recipients of the grant, which is the first cannabis-related grant awarded to any group at the Riverside campus.
“Scientists are still not sure how exactly long-term, or chronic cannabis use affects health and a variety of tobacco-related pathologies, such as type 2 diabetes, and other metabolic diseases,” said DiPatrizio, in a press release from the university. “We expect the knowledge we will gain in this project will help guide science-based public policy associated with the health impact of short-term and long-term cannabis use.”
Cannabis and the body
Good metabolic health is associated with ideal levels of blood sugar, triglycerides, cholesterol, blood pressure, and waist circumference. People with poorer metabolic health often have high triglyceride levels and blood pressure, and a larger waist circumference than average. In addition, many people with poor metabolic health also find that their body becomes unable to control its normal blood sugar levels. Poor metabolic health can lead to an increased risk for heart disease, stroke, and diabetes.
While short-term cannabis use is often associated with the “munchies” and overeating, long-term frequent cannabis use has conversely been linked to lower body weights. In addition, DiPatrizio has also claimed that long-term cannabis use can lead to improvements in other metabolic parameters, such as promoting higher levels of “good cholesterol.”
Receptors for the body’s endocannabinoid system are present in many areas of the body, including the central nervous system and all peripheral organs. While the endocannabinoid system is probably best known for the intoxicating effects it can produce if activated by the correct cannabinoids, the system is also an active part in many of the body’s ordinary physiological functions, including food intake and metabolic regulation.
Studying cannabis and metabolic health
DiPatrizio’s lab has designed an experiment which will allow them to study how cannabis affects the stable equilibrium of glucose (or “glucose homeostasis”) in the body. As type 2 diabetes is marked by higher-than-normal levels of glucose in the blood, studying this should also provide a good assessment of whether long-term cannabis use might affect rates of developing type 2 diabetes.
“We will investigate in wild-type mice whether cannabis exposure is linked to higher incidence of type 2 diabetes,” said DiPatrizio. “We will also investigate how important the endocannabinoid system, which cannabis hijacks, is for maintaining glucose homeostasis and if cannabis exposure dysregulates the process.”
DiPatrizio explains that glucose homeostasis in humans and mammals is controlled by the release of incretins – metabolic hormones that modulate insulin secretion to stabilize blood sugar levels – from the small intestine.
His experiment aims to assess the impact of exposure to the cannabinoid tetrahydrocannabinol (THC) on incretin release in wild-type mice, and in mice that have been engineered to lack cannabinoid receptor in the small intestine and related areas. A control group of mice will be fed a normal diet designed to keep the mice lean, while the experiment group will be fed a “western diet,” which centers high-fat and high-sugar foods and aims to bring on obesity.
“We will explore if THC makes the obese mice leaner with improvements in metabolism,” DiPatrizio said. “We expect to find the endocannabinoid system in the small intestines of the lean mice controls incretin release and glucose homeostasis. Further, we suspect the endocannabinoid system becomes dysregulated in the obese mice and participates in cannabis-induced changes in metabolic function.”
How Cannabis May Help Treat Type 2 Diabetes
Cannabis has been used as an herbal medicine within cultures for thousands of years. After a brief and corrupt period of prohibition, the herb is once again reaching its well-deserved status as a truly healing medicine. Modern science continues to observe the plant in detail and has so far discovered that many of the constituents within, such as cannabinoids and terpenes, have the ability to improve human health and treat certain diseases and conditions.
On top of the plant’s effectiveness, it is also extremely safe and there are no deaths attributed to toxicity. The list of diseases and ailments that cannabis is proving to be effective for is becoming extremely long. One of these diseases is diabetes. Let’s explore the risk factors and causes of the condition, before looking into the possible therapeutic effects that cannabis has to offer.
TYPES AND STATISTICS
There are two separate types of diabetes. Type 1 is a genetic disorder in which people’s bodies cannot produce insulin, a peptide hormone responsible for controlling blood glucose levels. Type 2 diabetes, or diabetes mellitus, is far more common and occurs when a person’s body cannot produce enough insulin, or the insulin that is produced is not working efficiently.
A report from the American Diabetes Association detailed the prevalence of the disease during 2015 within the United States. It was found that 30.3 million Americans, or 9.4% of the population, had diabetes. Of this population, approximately 1.23 million American adults and children had type 1 diabetes. The condition was the 7th leading cause of death within the country during the same year, associated with a total of 79,535 deaths.
CAUSES OF TYPE 2 DIABETES
Type 2 diabetes occurs when the pancreas, a large gland located behind the stomach, doesn’t produce enough insulin. When this happens, a normal blood glucose level cannot be maintained. The condition can also arise when the body is unable to use the insulin that is produced, a situation known as insulin resistance.
There are numerous risk factors that are associated with type 2 diabetes, and any of them can increase the chances of an individual being diagnosed with the condition. Age is one of these risk factors, and one that is highly influenced by race. Being over 40 is classed as a risk factor for developing type 2 diabetes for white people. However, these numbers fluctuate. Being over 25 is a risk factor for South Asian, Chinese, African-Caribbean or black African populations. Age is theorised to increase risk due to the possibility of weight gain and less exercise.
Genetics also play a role within the condition. Having a close relative such as a parent or sibling with type 2 diabetes is associated with a 1 in 3 risk of developing the condition.
Finally, being overweight or obese is heavily associated with type 2 diabetes. As human beings, our bodies are extremely adaptive to our environment, including the way we move and the foods we choose to indulge in. Moving well, lifting weights, and eating healthy foods will positively affect our epigenetic expression and lead to a state of well-being.
However, doing the opposite can lead to weight gain and the chronic diseases that come along with it, including type 2 diabetes. A body mass index (BMI) of 25 puts an individual within the overweight range, and a BMI of 30 or above places them into the obese range, further increasing the risk of type 2 diabetes. However, Asians with a BMI of 23 or higher are at an increased risk, while Asians with a BMI of 27.5 or above are even more at risk.
Stored fat around the abdomen can greatly increase the risk of developing type 2 diabetes. Stored fat within this area of the body releases chemicals that can disrupt the cardiovascular and metabolic systems within the body. This can also boost the risk of developing other serious conditions such as coronary heart disease, stroke, and some forms of cancer.
For most people, the idea that cannabis may be able to assist with such a serious disease may seem absolutely absurd. Many people see the herb as a dangerous, illicit drug that has no place in modern medicine. The truth is, this point of view has been cultivated by decades of propaganda and political manipulation. When we look at the hard facts in the form of scientific publications, we see that cannabis is an extremely potent and complex medicine that works with the body in a very powerful and specific manner. This occurs via the endocannabinoid system, a network of receptors that are activated by the molecules found within the cannabis plant.
So, how exactly can this plant work to prevent and possibly treat diabetes? Well, the main mechanism may involve weight management, an important factor when considering the extremely close relation between obesity, BMI, and type 2 diabetes. This may seem surprising considering certain stereotypes associated with consuming cannabis, such as the overindulgence in food, laziness, and lack of exercise. It turns out, these may very well be fictitious accounts perpetuated by pop culture over time.
CANNABIS AND OBESITY
A scientific publication within the American Journal of Epidemiology examines the link between obesity and cannabis use by applying the results from two representative national surveys. The researchers found that cannabis users are actually less likely to be obese than non-users in the general population. This result was the opposite of the initial hypothesis, which was based on clinical trials and laboratory studies that linked cannabis to appetite stimulation.
The publication also invokes numerous studies that show similar results. One such study consisting of 297 women suggested that the rate of cannabis use in the last 12 months was lower in obese subjects than it was in women with a lower BMI. Another study showed a contrasting result, displaying that frequent cannabis usage was associated with obesity in girls in a sample of 7,885 adolescents. However, another study showed that although cannabis is associated with higher caloric intake, people using cannabis are less likely to be obese than those who do not use it.
So, what do these results indicate? Well, based on these studies, cannabis does have a strong correlation with a healthy weight. Does this mean that a healthy weight cannot be achieved without the use of cannabis? Certainly not, exercise and nutrition are still key. However, there does seems to be room for the herb as a potential preventative measure.
One of the reasons that cannabis may be linked to a healthier weight is due to an enhanced carbohydrate metabolism. Murray Mittleman, an associate professor of medicine at Harvard Medical School has been quoted saying, “The most important finding is that current users of marijuana appeared to have better carbohydrate metabolism than nonusers.”
The research that led to this statement included over 4,600 men and women. 49% of subjects had smoked cannabis at least once during their lifetime, and 12% smoked the herb frequently. It was found that current cannabis users had fasting insulin levels that were 16% lower than former users and those who had never smoked. Cannabis smokers also displayed a 17% reduction in another measure of insulin resistance. Mittleman also stated, “Their fasting insulin levels were lower, and they appeared to be less resistant to insulin produced by their body to maintain a normal blood-sugar level.”
CANNABIS IN DIABETES DRUGS
The UK-based company GW Pharmaceuticals is currently in the process of developing a cannabis drug that will potentially eliminate the need for insulin injections when it comes to diabetes. The company has already developed an oral spray called Sativex, a prescription medication used for the muscle spasms involved in multiple sclerosis. This new drug aims to use cannabinoids CBD and THCV, molecules shown to be effective for lowering blood sugar and improving insulin production.
THCV is yet another powerful medicinal cannabinoid. Known in full as tetrahydrocannabivarin, THCV has been found to offer an array of health benefits that may be particularly useful to diabetics. For one, THCV has been shown to be an appetite suppressant. This means it may have the ability to manage weight in obese patients.
A scientific study published by the American Diabetes Association looked into the efficacy and safety of both THCV and CBD on patients with type 2 diabetes. The researchers involved in the study mention that THCV significantly decreased fasting plasma glucose, stating, “These findings suggest that THCV may represent a new therapeutic agent for glycemic control in subjects with type 2 diabetes.”
A growing number of states are mulling legalizing medical marijuana, but is pot as harmless as people think?
On ‘Fox & Friends,’ author of ‘Tell Your Children’ Alex Berenson warns that scientific studies are showing how dangerous cannabis is.
Last year, the FDA recognized a new drug for epilepsy made from marijuana’s own CBD, otherwise known as cannabidiol. That means the marijuana plant may have a confirmed medical use after all.
So what about medical marijuana and diabetes? Can diabetics use the drug to help their condition or safely use it for pleasure?
As more states legalize medical marijuana, people with all kinds of diseases are wondering this same question.
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However, diabetics are left reading between the lines of existing studies to make a conclusion. The short answer: experts don’t know for sure.
People with diabetes can discuss how to safely use medical marijuana with their doctors. However, the research is slim and sometimes opposing on whether the drug actually helps diabetes.
One large study published in The American Journal of Medicine points to positive benefits for diabetes.
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The study was conducted on over 4,600 participants using the National Health and Nutrition Examination Survey (NHANES) survey. Of those participating, about 580 used marijuana regularly and over 1,900 had used it in the past. Interestingly, researchers found that using marijuana was associated with a lower fasting insulin level and a smaller waist size.
A review published in the Natural Medicine Journal also highlighted positive outcomes. The review cited the NHANES study as well as several mice models that suggest cannabis protected mice from getting diabetes or reduced its severity.
The review also pointed out a study in Israel that revealed a low dose of THC, well below its psychoactive capabilities, could protect the body against organ damage.
But there are studies showing negative effects too. One such study published by the American Diabetes Association showed that marijuana users tended to consume about 20 percent more food, eat a lesser quality diet involving simple carbs, have higher blood pressure and have a higher percentage of visceral fat.
All of these markers could exacerbate diabetes risk. To balance these findings, though, the same study did find that marijuana users had lower overall fat content and a lower BMI.
Other possible (largely unproven) benefits of medical marijuana that many cannabis advocates commonly highlight:
? Reducing anxiety
? Reducing pain and inflammation
? Slowing cancer growth
? Muscle relaxant, which could be helpful for multiple sclerosis
? Controlling side effects of chemotherapy, such as nausea and vomiting
Officially, the National Institute on Drug Abuse states that not enough large-scale studies have been conducted to provide definitive answers about medical marijuana. One thing is certain, though: In light of the new wave of cannabis interest, this is a field of study researchers cannot overlook.
The difficult task is to conduct such research under available laws, which prohibit the use and study of marijuana by the federal government. Researchers will need to take care to go the proper pathways so that more research can become available and recognized.
Marijuana Use Linked to Prediabetes
Does cannabis protect against blood sugar problems…or ignite them? Several big population studies hint at an intriguing association between marijuana and lower risk for type 2 diabetes. But a recent University of Minnesota study has uncovered 49-65% higher odds for prediabetes in current smokers and former “heavy” users. The study was published in the September issue of the journal Diabetologia.
Researchers used data from the large, on-going CARDIA (Coronary Artery Risk Development in Young Adults) study, which is studying heart disease development in 5,115 black and Caucasian women and men over several decades. For this study, they looked at associations between marijuana use and blood-sugar levels in a group of 3,034 study volunteers 25 years after the study began in the mid-1980s. They also looked at 3,151 volunteers who did not have prediabetes or diabetes in 1992-1993 to see, in follow-up exams, how blood sugar levels changed for pot users and abstainers.
Overall, marijuana use dropped from 28% at the start of the study to 12% by 2010. By then, current smokers had a 65% higher risk for prediabetes. And former users who smoked or otherwise ingested marijuana at least 100 times in the past had a 49% higher risk for prediabetes. But pot wasn’t associated with higher risk for full-blown type 2 diabetes. “Marijuana may have a more noticeable impact on glycemic metabolism in the prediabetes range compared with the diabetes range,” says lead researcher Michael Bancks, a doctoral student at the University of Minnesota School of Public Health. In contrast, traditional risk factors like obesity may overshadow the effects of marijuana in people who do develop diabetes, he adds.
THC and A1c
Nearly 19 million Americans use marijuana. But “despite the growing movement to legalize marijuana, little is known about its effect on metabolic health,” Bancks and his coauthors from the University of California, San Francisco, the University of Alabama at Birmingham and Kaiser Permanente Northern California note in the study.
A string of epidemiological studies have turned up an association between the drug and lower risk for diabetes. In a 2013 study from Harvard Medical School of the health records of 4,657 people, marijuana users had lower fasting insulin levels and less insulin resistance than non-users. And in July of 2015, Michigan State University researchers analyzed eight studies and found a 30% lower diabetes risk for current marijuana users. They concluded that “current evidence is too weak for causal inference” but that marijuana’s effects on blood sugar were worth more study.
Researchers aren’t sure what might be at work. But they (and cannabis fans) do know that tetrahydrocannabinol — THC, the major “active ingredient” in marijuana—stimulates the body’s endocannabinoid system, which helps regulate appetite (explaining the “munchies”), impulse control and body weight as well as blood sugar. Lab studies looking at THC’s role more directly have found that, at least in rats, THC seemed to protect against high blood sugar.
But it’s not clear how beneficial marijuana or THC may be. When National Institutes of Health researchers took a closer look at the metabolic health of 30 cannabis smokers and 30 non-smokers, they found that marijuana users had more abdominal fat and their fat cells were more insulin resistant. And other studies have found higher blood-sugar and insulin levels among former users compared to nonusers, according to a 2013 University of Miami review. Burning cannabis also releases substances that can damage cells, Bancks notes. “Marijuana smoke is shown to increase the production of reactive oxygen species and oxidative stress,” he says. “This means the overall physiological process occurring with marijuana use may be complex.”
Good for Blood Sugar? Not Yet
So, should you smoke, or snack on brownies spiced with cannabis, for your blood sugar? “There is not enough evidence to start using marijuana for diabetes prevention or diabetes treatment for that matter,” says registered dietitian and certified diabetes educator Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE of the Kovler Diabetes Center in Chicago and an EndocrineWeb advisor. “Until there are large scale studies that can prove otherwise, it should not be recommended for this at all.”
“Based on the marijuana users I see in clinical practice, they all state they experience “the munchies” and tend to overeat junk food (or anything in sight). The unabashed eating could contribute to the increased visceral fat. And for the young adults I work with who use marijuana, we have long conversations about how it affects cognitive function,” she adds. “They may not take their insulin correctly or take too much. Being high could also mask low blood sugar symptoms and the person could have a very severe and dangerous low.”
Last updated on 09/25/2015 Continue Reading Using Marijuana to Treat Diabetic Nerve Pain View Sources