Knowledge grows about cannabis, CBD use by people with diabetes
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Susan Weiner, MS, RDN, CDCES, FADCES, talks with Janice Newell Bissex, MS, RDN, FAND, about potential health benefits of cannabis and CBD for diabetes.
It is possible that cannabis may help with blood glucose management, decrease arterial inflammation, improve neuropathy and lower blood pressure, according to Bissex. Navigating the legal and accessibility issues and finding quality guidance are some of the obstacles people face when it comes to cannabinoid therapy for diabetes.
Weiner: With the legalization in some states of medical and adult use cannabis, and the federal legalization of hemp production, has the use of these products increased among people with diabetes?
Bissex: In an analysis published in 2022 of data from the International Cannabis Policy Study collected in 2018 across Canada and the U.S., researchers found that 27% of people living in North America reported having used medical cannabis to manage pain (53%), reduce anxiety (52%) or improve sleep (46%). Mirroring the general population, use of cannabis and CBD has increased among people with diabetes. A study published in 2020 of findings from the National Survey on Drug Use and Health showed that cannabis use prevalence among adults with diabetes increased 340% from 2005 to 2018. Expanding legalization, decrease in stigma and more awareness of potential benefits have likely contributed to an increase in cannabis and CBD use.
Weiner: Do we know what effects use of these products has on diabetes?
Bissex: Cannabis and CBD interact with the endocannabinoid system, which is involved in lipid and glucose metabolism. CBD targets the body’s G protein-coupled receptors (GPCRs), which are widespread and affect many bodily functions. Most of the medications prescribed for diabetes also target GPCRs.
Inflammation and oxidative stress are factors in the development of and complications from diabetes and other chronic diseases. Cannabinoids found in the cannabis plant have well-documented anti-inflammatory and antioxidant effects. Eating a diet that includes plants, whole grains and healthy fats, managing stress and exercising can also help to keep inflammation and oxidative stress in check.
There are no reports of blood glucose worsening with cannabis use. In fact, an analysis published in 2013 of data from the National Health and Nutrition Examination Survey found that cannabis use is associated with a 16% lower level of fasting insulin and 17% lower insulin resistance. Based on this, it should come as no surprise that cannabis users may have a lower incidence of type 2 diabetes than the general population.
Two of the cannabinoids in the cannabis plant that have been identified as particularly helpful for diabetes are THCv and CBD. In addition, a terpene found in cannabis, beta-caryophyllene, plays a role in lipid and glucose metabolism and has antidiabetic potential.
A 2016 study published in Diabetes Care found that the cannabinoid THCv significantly decreased fasting blood glucose levels. CBD was found to decrease resistin and increase gastric inhibitory polypeptide, which stimulates insulin secretion. Another study, published in 2006, showed that CBD significantly reduced the incidence of diabetes in nonobese diabetic mice (86% vs. 30%). These CBD supplemented mice also displayed a decrease in inflammatory cytokine release.
Weiner: What products are available and how do they differ?
Bissex: Cannabis is most commonly consumed via smoking, vaping, tinctures, capsules and edibles. There are pros and cons to each method. Smoking and vaping provide the fastest relief for severe pain, whereas capsules and edibles are longer lasting with a delayed onset. Tinctures take effect in about 15 minutes and allow for titration of dosing based on how someone is feeling.
As mentioned above, THCv has been shown to decrease fasting blood glucose levels. This cannabinoid is not as commonly found in cannabis products, so searching for a cultivar with higher levels of THCv (such as Doug’s Varin and Durban Poison) will take some research.
CBD may be an easier way to start getting potential benefits for people living with diabetes. There are many CBD companies, but the FDA found that 70% of the CBD products on the market are mislabeled — so buyer beware. Always ask for a certificate of analysis (COA) to make sure what is claimed on the label is actually in the product. I recommend looking for organically grown CBD from the U.S. from a trusted source with someone who can answer questions about appropriate methods of administration and dosing.
There are three types of CBD products to consider. Full-spectrum CBD products contain all the cannabinoids, terpenes and flavonoids in the plant, including THC, the cannabinoid best known for producing the “high.” The maximum amount of THC allowed in hemp CBD products is 0.3%, which is not enough to be intoxicating.
Those who are not comfortable with THC should choose a broad-spectrum product, which contains all the cannabinoids, terpenes and flavonoids in the plant, minus the THC. Isolate CBD contains only the CBD molecule and is not nearly as effective since it lacks the “entourage” or “ensemble” effect — synergy between the components in the plant.
Topical CBD may help with neuropathic pain. One client told me she “woke up with two new feet” after applying a CBD salve before bed.
Weiner: Do these products interact with drugs prescribed to treat diabetes?
Bissex: According to Drugs.com, there are no known interactions between CBD or cannabis and insulin, metformin, glipizide, glimepiride, canagliflozin (Invokana, Janssen), empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) or sitagliptin (Januvia, Merck). Ingestible CBD may interact with medications that are processed by the CYP450 enzyme system, such as warfarin. Using tinctures and topicals will help to avoid the first pass metabolism in the liver to attenuate any risk for interaction.
Weiner: What advice do you give people with diabetes interested in these products?
Bissex: Do your homework and work with a practitioner who understands the science of cannabinoid therapy and can guide you. Always start low and go slow when it comes to dosing. I’ve been to cannabis dispensaries where they’ve recommended a 10 mg THC gummy. This is way too high a dose for anyone not accustomed to using cannabis and would likely cause unwanted side effects, such as rapid heart rate, dry mouth and disorientation. CBD does not cause these uncomfortable side effects, but it is best to start with a low dose.
Exciting research into the potential benefits of CBD and cannabis therapy for diabetes is ongoing. We need more clinical trials to determine the best cannabinoid ratios and dosing. The first step is to legalize this plant to both increase access to cannabis medicine and to allow for more research.
References:
- Brook E, et al. Pharmacol Res. 2019;doi:10.1016/j.phrs.2019.01.009.
- Danielsson AK, et al. J Diabetes Res. 2016;doi:10.1155/2016/6278709.
- Jadoon KA, et al. Diabetes Care. 2016;doi:10.2337/dc16-0650.
- Leung J, et al. Psychopharmacology (Berl). 2022;doi:10.1007/s00213-021-06047-8.
- Maurya A, et al. Curr Top Med Chem. 2021;doi:10.2174/1568026621666210305102500.
- Penner EA, et al. Am J Med. 2013;doi:10.1016/j.amjmed.2013.03.002.
- Sexton TR, et al. Drug Alcohol Depend. 2020;doi:10.1016/j.drugalcdep.2020.108035.
- Weiss L, et al. Autoimmunity. 2006;doi:10.1080/08916930500356674.
For more information:
Janice Newell Bissex, MS, RDN, FAND, is a holistic cannabis practitioner at Jannabis Wellness and program director of Cannabinoid Medical Sciences at John Patrick University of Health and Applied Sciences in South Bend, Indiana. She can be reached at: jannabiswellness@gmail.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.
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