Can cannabis use be linked to a risk of diabetic ketoacidosis?

Cannabis, also known as marijuana, is now legalized in Canada, but its effects in relation to diabetes remain poorly known.

Previous studies have found links between cannabis use and improved insulin sensitivity in people living with type 2 diabetes. Which means that cannabis use may increase the body’s ability to metabolize sugar in the blood by making insulin more effective.

However, new studies shed some light on the potential impact of cannabis on the management of blood sugar more specifically in the context of type 1 diabetes. A study published in January 2019 reports that the risk of ketoacidosis is higher among people living with type 1 diabetes who have used cannabis in the last year. Ketoacidosis is a severe complication of diabetes associated with high blood sugar and lack of insulin causing the build-up of ketone bodies that acidify the blood. It can lead to coma, even death, if it is no taken care of in time.

The study was conducted in Colorado with 450 people living with type 1 diabetes, about 30% of whom said they had used cannabis in the last year.

What does the study show?

  • A risk of ketoacidosis about 2 times higher in people who have used cannabis in the last year.
  • Higher average blood sugar levels in consumers. In fact, average glycated hemoglobin (A1C) was 7.6 % among non-consumers, compared to 8.4 % among consumers.
  • A risk of severe hypoglycemia comparable for both groups.

The reasons remain to be studied

The study focused on collecting data on blood sugar, ketoacidosis and cannabis use among people living with type 1 diabetes and did not look for how cannabis could directly or indirectly affect blood sugar and the risk of ketoacidosis.

  • It should be noted, however, that the use of technology was lower among people who used cannabis. More limited access to continuous glucose reading may explain higher blood glucose levels without a direct link to cannabis use.
  • There is a « cannabinoid hyperemesis syndrome », also called « cannabinoid syndrome », which is manifested by significant vomiting and may promote the occurrence of ketoacidosis.
  • It is also possible that the effects of cannabis significantly change the symptoms associated with hyper and hypoglycemia.
  • Cannabis can also have significant effects on appetite and therefore on blood glucose levels. Some cannabis products (cookies, etc.) contain carbohydrates that must be included in the calculation of carbohydrates.

The impact of cannabis on diabetes would therefore be different depending on the type of diabetes and could pose a higher risk for people living with type 1 diabetes. New studies are needed to provide more information on the effects and consequences of cannabis use among people living with type 1 diabetes. In case of consumption, it is important to be more vigilant and to carefully monitor the glucose. This vigilance is even more applicable when cannabis is used with alcohol although no study has been done on the subject.

Références :

  • Akturk, Halis K, Daniel D Taylor, Ulas M Camsari, Amanda Rewers, Gregory L Kinney, and Viral N Shah. 2019. “Association between Cannabis Use and Risk for Diabetic Ketoacidosis in Adults with Type 1 Diabetes.” Jama Internal Medicine 179 (1): 115–15. doi:10.1001/jamainternmed.2018.5142.
  • Jadoon KA, Ratcliffe SH, Barrett DA, et al. Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled, parallel group pilot study. Diabetes Care. 2016;39(10):1777-1786. doi:10.2337/dc16-0650
  • Penner EA, Buettner H, Mittleman MA. The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. Am J Med. 2013;126(7): 583-589. doi:10.1016/j.amjmed.2013.03.002

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