Cannabis users may have a heightened risk of diabetes, according to new research presented at this year’s Annual Meeting of the European Association for the Study of Diabetes in Vienna, Austria (September 15-19). This new research highlights the importance of screening for substance use disorders among diabetic patients.
Researchers found that people who reported using cannabis were nearly four times more likely to develop type 2 diabetes than non-users. Even after controlling for cholesterol, blood pressure, heart disease and alcohol or cocaine use, this significant link remained.
1. Increased Risk of Hypoglycemia
In addition to the risk of hypoglycemia, cannabis can also cause a wide range of other symptoms including nausea and vomiting, dizziness, lethargy, and trouble thinking. These symptoms can be difficult to recognize and treat, leading to severe hypoglycemia, which can be fatal if not treated immediately. Symptoms of mild to moderate hypoglycemia can be treated by eating food or glucose tablets, drinking fluids, and monitoring blood sugar levels. Severe cases can be treated with glucagon hormone injections or by seeking medical attention.
A study published this month in Diabetes Care found that regular marijuana use increases the risk of developing diabetes by 3.7 times. Researchers analyzed data from 54 healthcare organizations across the U.S and Europe. They looked at records from 96,795 individuals between the ages of 18 and 50 who used cannabis in some form, ranging from occasional to dependence. They were compared to 4,160,998 healthy people of the same age and gender with no record of marijuana use. They accounted for other lifestyle risk factors like uncontrolled high blood pressure and cholesterol, alcohol or cocaine use, and smoking status.
The results showed that even after adjusting for these other risk factors, those who reported using marijuana were at greater risk of developing diabetes than non-users. The researchers note that this increased risk is likely due to the fact that marijuana use is often associated with poor dietary choices, which can lead to weight gain and insulin resistance.
They also pointed out that recreational cannabis users are more likely to engage in other unhealthy behaviours, such as tobacco and alcohol consumption, which can further impact glucose metabolism and self-care practices. They stressed that these findings emphasize the need for health care professionals to routinely talk to their patients about their cannabis use so that they can understand how it could affect their diabetes risks and need for metabolic monitoring.
While more research is needed to fully understand the link between cannabis and diabetes, it is possible that the drug directly affects glucose regulation through overstimulation of the endocannabinoid system, causing insulin resistance and fat accumulation. This may be further exacerbated by the “munchies” effect, which leads to cravings for high-calorie foods.
2. Increased Risk of Diabetic Ketoacidosis (DKA)
Cannabis users may have a heightened risk of diabetic ketoacidosis (DKA), a life-threatening condition that occurs when the body is unable to use its glucose for energy, leading to high levels of ketone bodies in the blood. The condition can be caused by heavy or prolonged usage of marijuana, or by consuming foods that raise blood sugar levels like candy or cookies. People with diabetes who use marijuana should discuss their consumption with their healthcare provider or support team. Together, they can make a plan for how to consume the drug and ensure that their glucose levels are properly monitored before, during, and after each use.
A recent study of real-world data found that adults who use cannabis are nearly four times more likely to develop type 2 diabetes than those who do not. The researchers analyzed medical records from 54 health care organizations across the U.S. and Europe through the TriNetX Research Network. They matched 96,795 adults with cannabis-related diagnoses (ranging from casual use to dependence) to 4,160,998 healthy individuals who did not have any record of substance abuse or chronic illness. Over the course of five years, 2.2% of the cannabis-using group developed type 2 diabetes compared to 0.6% of non-users.
The results indicated that the occurrence of prediabetes was significantly higher in the marijuana using group versus the never-using group, even after accounting for a number of potential confounding variables. The results also demonstrated that the incidence of prediabetes was influenced by the frequency and duration of marijuana use during young adulthood. In particular, the greater lifetime frequency of marijuana use at baseline was associated with a higher incidence of prediabetes by middle age.
While marijuana by itself does not raise glucose levels, many of the side effects associated with its use can lead to a rise in blood sugar levels, including nausea and vomiting. These side effects can interfere with a person’s ability to follow their meal plan and can result in uncontrolled blood sugar levels. This can then lead to serious complications, such as DKA or hyperglycemia with coma (HHC). DKA can be identified by symptoms that include rapid breathing, fast heart rate, and dehydration. It is diagnosed by measuring the level of ketone (acid) in the blood, checking arterial pH, and checking serum bicarbonate.
3. Increased Risk of Hypoglycemia Withdrawal
Cannabis can be a powerful stimulant that may cause cravings for high-carbohydrate foods. This can lead to overeating and weight gain, which are common in people with diabetes. This can negatively affect glycemic control, and also make it harder to manage other health conditions such as cardiovascular disease. Cannabis can also cause a feeling of euphoria, which can interfere with proper diabetes management and self-care.
A new analysis of real-world data shows that recreational cannabis use is linked to an almost quadrupling of the risk of developing diabetes.
The findings were based on the National Surveys on Drug Use and Health (NSDUH), which relies on self-reporting of substance use, including cannabis, by participants. The analyses used weights to adjust for selection and response bias, while imputation techniques were employed where necessary to limit missing data. Discrepancies were resolved consistently by an independent third reviewer.
Using data from NSDUH, researchers compared the risk of prediabetes or diabetes by age and gender, adjusting for various characteristics. The results showed that recreational cannabis use was associated with an increased risk for diabetes in those with type 1 diabetes, but this increase was attenuated after adjustment for basic demographic and lifestyle factors such as BMI and dietary habits, blood pressure, and pack-years of cigarette smoking.
Moderate cannabis use was also associated with a doubled risk of diabetic ketoacidosis in those with type 1 diabetes, largely due to forgetting to take their medications and eating high-carbohydrate foods, which can result in dehydration and low blood sugar.
The authors of the new analysis recommend that healthcare providers ask patients about their recreational cannabis use without judgment and include this information in their medical histories. They also recommend that a comprehensive substance-use screening be part of diabetes care and that cannabis use be considered in addition to other established risk factors, such as tobacco and excessive alcohol consumption, when considering the risk of diabetes. The authors acknowledge that there is still limited knowledge of the long-term metabolic effects of cannabis and caution that broader research on this topic is needed.
4. Increased Risk of Hypoglycemia Withdrawal
Those with type 1 diabetes may be at increased risk of developing diabetic ketoacidosis (DKA) when they use cannabis. This is mainly due to a combination of the effects of cannabis on the body’s hormone system and poor diabetes self-management. It also has to do with a particular type of cannabis called “sativa,” which can cause severe food cravings known as the “munchies.” When people have the munchies, they will eat more carbohydrate foods and have higher blood sugar levels than usual. In addition, the drug can interfere with insulin and other medications used to treat diabetes.
In a study involving 138 college students with T1D, recreational cannabis use more than doubled the risk of DKA in these individuals. This was primarily because the participants were not managing their diabetes as well, such as eating high-carb foods and forgetting to take their medication. The researchers believe that the brain region responsible for regulating appetite and metabolism is affected by the drug, which can lead to poor diet and lower blood sugar control.
Other studies have shown that those who use marijuana are at a higher risk for developing prediabetes or even type 2 diabetes. Researchers from Boston Medical Center, Massachusetts, U.S. analyzed medical records from 54 healthcare organizations across the country and Europe as part of the TriNetX Research Network, then matched 96,800 people who reported cannabis-related diagnoses—from casual users to those with dependency—with 4.16 million others who did not have any substance or chronic illness-related diagnosis. Over a five-year period, the team found that those who used marijuana had an almost quadrupling risk of developing prediabetes or diabetes compared with non-users.
As cannabis use continues to rise in Canada, and as it becomes legalized in other parts of the world, it is important that people with diabetes and other conditions understand its risks. That’s why Diabetes Canada approached the Strategy for Patient-Oriented Research Evidence Alliance (SPOR) to conduct a rapid review of the literature within a short timeline. The final report, published in the journal PLOS ONE, provides an overview of current evidence about the impact of recreational cannabis on people with diabetes and offers some recommendations for care.
