May 20, 2021 Cannabis and diabetes

Cannabis goes by many names, including marijuana, weed, and pot. In October 2018, it became legal for Canadians to use cannabis recreationally. But is it safe for people with diabetes?

“The safety of recreational cannabis has not been demonstrated for people with diabetes,” says Dr. Seema Nagpal, who is an epidemiologist (epidemiology shapes policy decisions and best practices by identifying risk factors for disease and targets for preventive health care) and Diabetes Canada’s former vice president of Science and Policy. She adds,

Based on current information, regular cannabis use seems to be associated with blood sugar levels outside the target range, more diabetes-related complications, and an inability to perform self-care behaviours, such as adequate monitoring, taking medications, or implementing dietary and physical activity behaviours as agreed with their provider.

To learn more about this issue, Diabetes Dialogue spoke to her and also to Dr. Harpreet Bajaj, an endocrinologist who volunteers with Diabetes Canada’s professional section and is the Clinical Practice Guidelines chair. Along with other experts, the two co-authored Diabetes Canada’s position statement on cannabis use, which was developed with research-backed recommendations.

What should Canadians living with diabetes know about recreational cannabis?

Bajaj: The federal government, and provincial governments such as Ontario and British Columbia, have resources about recreational cannabis, the do’s and don’ts [of cannabis use], and what is known about the medical effects for people in general. All of that information applies to people with diabetes as well.

Beyond just general information, they should be aware that there are possible additional effects on diabetes, whether it’s glucose [sugar] control, [eating habits], or diabetes management. There is not a lot of high-quality research, but what research there is suggests that hemoglobin A1C [HbA1c]—which is the three-month average blood sugar that is tested in the lab—can go up by about 0.2 to 0.3 per cent on average among cannabis users. So it is important to understand that using cannabis can have that detrimental effect on glucose control.

At least five to six studies have suggested that the risk of diabetic ketoacidosis increases among cannabis users with type 1 diabetes. Diabetic ketoacidosis happens when there is too much ketone production in the body; this leads to acidic blood, which can be a life-threatening complication of type 1 diabetes. If you are using recreational cannabis, you should be aware of this risk, and check your blood sugars and ketones more often.

Nagpal: People should speak with their healthcare professionals on a regular basis about any substance use. This open discussion is very important to ensure the best possible health and safety.

Can cannabis be safely used in moderation by people with diabetes, or should they not use it at all?

Bajaj: We suggest that if you don’t already use cannabis, you should not start. My recommendation, especially with type 1 diabetes, is to minimize or stop using it if possible. Minimizing includes the frequency and amount of use. This is because of the increased risk of diabetic ketoacidosis.

If a patient with type 2 diabetes is using recreational cannabis, and their glucose control is within the target range, and they’re still practising healthy behaviours and following all the necessary testing, then I would say it’s okay to continue, within limits. In a person whose diabetes goals are not achieved, I would discuss their goals with them and my suggestion would be to try and stop, or at least cut down on the frequency and amount consumed.

What type of research would you like to see on this topic? What information do we need?

Nagpal: Further studies will be able to inform us as to whether the legalization of cannabis has changed [patterns of] use in Canada, the health outcomes with that use, and if there have been additional harms for people living with diabetes. The specific consequences associated with vaping, smoking, and edibles with diabetes management are not yet well described.

Did you know?

Cannabis use among people with type 1 diabetes has been linked with an increased risk for diabetic ketoacidosis. Learn more in Diabetes Canada’s position paper on recreational cannabis use among people with type 1 or type 2 diabetes.

This article originally appeared in Diabetes Dialogue.