Many people with diabetes use cannabis or marijuana. Some do so recreationally, while others choose the substance for its potential health benefits, which may include relief from nausea or painful neuropathy and improved mood or sleep.
Diabetes authorities, however, caution against using the drug, as it has not been thoroughly studied in people with diabetes, could enhance short-term diabetes management risks, and is generally associated with negative long-term health effects.
There’s not a lot of research on how cannabis use may impact those who have diabetes, says Scott Pilla, MD, a member of the American Diabetes Association’s professional practice committee and an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore. “In general,” Dr. Pilla says, “it is not recommended … there really is very little research on long-term cannabis use, either as a therapeutic or recreationally.”
Health authorities generally recommend against the use of cannabis, for people both with and without diabetes, but there are clinicians who support its use. Desiree Granados, MD, an integrative medicine specialist in Fort Myers, Florida, who specializes in weight and blood sugar management, says she generally considers cannabis safe for those who have diabetes.
Nevertheless, there are some obvious risks for people with diabetes involved with using any psychoactive substance. Cannabis can have mind-altering effects that could overlap with or mask the signs of both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). When you’re high on cannabis, it can be difficult to recognize when you need to take action or to make good self-care decisions.
Cautious cannabis users with diabetes recommend being extra careful while using the substance. Consider wearing a continuous glucose monitor (CGM) to remind you to check your blood glucose levels. And never use so much of the drug that it could impair your ability to take your medicine or recognize when you may be experiencing a blood-sugar related problem. It might be wise to use cannabis in the company of a sober friend or family member who understands your condition and can help you make good decisions in an emergency.
The “munchies” can also represent a significant hazard, especially for people who use insulin, says Pilla. “Anything that causes variations in dietary intake can cause hypoglycemia, especially for people using insulin who need to follow a good routine, so cannabis use would be a concern for me for anyone using insulin.”
“Some strains of cannabis can cause people to have an increased appetite, which could potentially lead to overeating sugary or carb-heavy snacks, leading to increase in blood sugar levels,” Dr. Granados says. “However, there are other strains that may not cause any change in appetite at all. Everyone responds to specific cannabis strains differently.”
People with diabetes should also be aware of any cravings that might influence unhealthy snacking or eating habits while they’re under the influence of marijuana. And cannabis edibles themselves may include substantial amounts of added sugar.
There are other short- and long-term risks unrelated to diabetes, including lung disease (when inhaled), impaired driving disasters, mental health problems, and memory loss. “From what we know, cannabis use is likely to have some adverse health effects including lung issues for cannabis smokers, and possibly cardiovascular and cognitive issues,” says Pilla.
Cannabis use may also impact other health conditions that people with diabetes frequently face. For example, the American Heart Association warns that cannabis use appears to be linked to cardiovascular risk factors.
Cannabis is an addictive substance, and excessive use can cause physical, mental, and social problems that could significantly interfere with your health and diabetes management.
There is no compelling evidence that cannabis has a strong direct impact on glucose metabolism and insulin sensitivity. The limited research on the subject is conflicting, and sometimes suggests that cannabis use does not have any effect on blood sugar levels.
“There have been some studies attempting to understand diabetes and cannabis correlation, but currently, there is no consensus regarding the effects of cannabis on glucose,” says Granados. “Some research shows that cannabis may cause an A1C increase in type 1 diabetes, but also that cannabis may help improve insulin sensitivity in people with type 2 diabetes.”
Though cannabis doesn’t seem to significantly affect blood sugar, it can offer relief for several other conditions common in people with diabetes, says Granados: “If you have nausea, chronic pain, or neuropathy from diabetes, marijuana may help control this and allow you to get better rest and decreased pain, which could potentially have benefits of better glucose control,” she says.
Some research supports these benefits. Cannabis may:
Offer short-term relief from neuropathic pain
Provide quick relief from nausea, which can be triggered by diabetes medications like metformin and GLP-1 receptor agonists like semaglutide (Ozempic) and complications such as gastroparesis.
Help ease mental health conditions such as anxiety and stress, which can be common in people who manage chronic illnesses.
These benefits can also help people do a better job of managing their diabetes, says Granados. “Blood sugar levels vary with stress, sleep, nausea, and physical activity,” she says. “All of these effects could lead to better blood glucose control.”
Heavy or chronic cannabis use, however, can have the opposite effect, increasing anxiety and the risk of other mental health issues, including depression, psychosis, and paranoia. These mental health conditions make it far more difficult to manage blood sugar levels, leading to diabetes complications and other negative health outcomes.
Tetrahydrocannabinol (THC) is the primary psychoactive compound in cannabis, but CBD, also known as cannabidiol, is another component of the cannabis plant that has medicinal properties. It doesn’t have the same intoxicating effect that THC does. Most authorities consider it a safe product, and CBD products are legal as long as they contain less than .3 percent THC.
Like THC cannabis products, CBD is found in oral tablets, pills, gummies, and tinctures, as well as topical balms and oils. The vast majority of health claims for CBD have not been substantiated by scientific research. Evidence is lacking that CBD affects glucose metabolism or blood sugar levels, and the American Diabetes Association states that “there is little evidence of any benefit” to CBD for people with diabetes. Nevertheless, the compound might have a positive effect on secondary issues common in diabetes, including pain, insomnia, and anxiety.
Medical and popular opinions of cannabis use have shifted significantly in the past few decades, and in some places the substance occupies something of a legal gray area. While the federal government still hasn’t legalized cannabis, 39 states currently allow the medical use of cannabis products, 24 allow recreational use, and its use among adults with diabetes is on the rise.
The U.S. Food and Drug Administration (FDA) has not approved the cannabis plant for any medical use, but the organization has approved several drugs that contain individual cannabinoids (a group of substances found in the cannabis plant) for the treatment of epilepsy, cancer, and HIV/AIDS.
If you use cannabis regularly and have type 1 diabetes, take note of a special warning: Regular cannabis users occasionally experience cannabis hyperemesis syndrome, a condition that causes recurrent nausea, vomiting, and abdominal pain, especially in the morning. People experiencing cannabis hyperemesis syndrome often find temporary relief from hot showers or baths. Since cannabis is thought to relieve nausea, some people with this syndrome may not suspect that cannabis is the cause.
For those with type 1 diabetes, this condition is especially dangerous. It can lead to a potentially deadly type of ketosis that roughly resembles diabetic ketoacidosis (DKA). Although patients do not develop the highly acidic blood characteristic of DKA, the symptoms are otherwise similar.
Pilla says that the risk of ketoacidosis makes it “especially important for people with type 1 diabetes to avoid cannabis use.”
If these symptoms sound familiar, discuss them with your endocrinologist. The best way to avoid or resolve this issue is to cease using cannabis products.
The Takeaway
It is unclear whether cannabis significantly affects the blood sugar levels of people with diabetes, but it could create a short-term danger if it clouds your judgment and inhibits your ability to make good self-care decisions. The risk is especially high for people who use insulin.
Cannabis may have some benefits for conditions that are common in people with diabetes, such as painful neuropathy, nausea, and anxiety, though it has not been approved to treat any of these symptoms in people with diabetes.
People with type 1 diabetes should be especially cautious about cannabis use. In rare cases, it can cause cannabis hyperemesis syndrome, which can spark a dangerous form of ketosis.
