The relationship between cannabis and diabetes is complex and not yet fully understood. To mark World Diabetes Day, we are dedicating this article to the possible benefits and risks of medical cannabis and CBD in managing diabetes. This article is based on the knowledge in the Principles of Clinical Cannabinology handbook, by Viola Brugnatelli and Dr Fabio Turco.
What is diabetes?
Diabetes mellitus is a chronic condition in which the body has elevated levels of glucose (sugar) in the blood due to problems with insulin, a hormone essential for regulating sugar in the body.
There are two main types of diabetes: in type 1 diabetes, the body does not produce enough insulin due to autoimmune destruction of pancreatic cells, and sufferers need insulin for life. In type 2 diabetes mellitus, the body does not use insulin properly, which is called insulin resistance, and this form is closely related to obesity and is more common.
Symptoms of diabetes vary, but may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, fatigue, blurred vision, slow wound healing, numbness or tingling in hands and feet, and frequent infections. These symptoms tend to develop gradually in type 2 diabetes, which can make early detection difficult, while in type 1 diabetes they usually appear suddenly and severely.
The relationship between the endocannabinoid system and diabetes
The endocannabinoid system (ECS) is a network of receptors and molecules in our body that helps regulate important functions such as metabolism, appetite and inflammation. This system interacts with compounds we produce naturally, called endocannabinoids, and also with compounds present in cannabis, such as THC and CBD.
Through the endocannabinoid system, cannabinoids may influence the regulation of metabolism and inflammation, showing potential to improve insulin sensitivity and reduce some symptoms and complications associated with diabetes.
The potential of cannabinoids in treating diabetes
Studies link certain alterations in the endocannabinoid system to metabolic problems such as insulin resistance and chronic inflammation, which could indicate new treatment targets for diabetes and obesity.
Detail: CB2 receptors as an anti-obesity agent
Some studies suggest that people with obesity, which is common in type 2 diabetes, have reduced functionality of CB2 cannabinoid receptors, which are part of the endocannabinoid system. Research has shown that in diabetic states these receptors are activated less strongly. This points to a possible link between the endocannabinoid system and metabolic problems such as insulin resistance and chronic inflammation.
This observation was supported by a study involving 501 children with obesity in Italy, which found impaired CB2 receptor functionality. In fat tissue cells studied in the laboratory, treatment with selective CB2 agonists reversed the inflammatory states induced by obesity. These findings suggest that modulating CB2 receptors could be a potential strategy for treating inflammation and other metabolic problems related to obesity and diabetes.
Cannabis, CBD and diabetes: current research
Arguably, there are currently two main perspectives on the use of medical cannabis in diabetes: one for and one against. Some studies suggest that it may improve insulin sensitivity and reduce inflammation, while others suggest that it may increase appetite and weight, which could worsen type 2 diabetes. In both cases, more research is needed to fully understand the effects of cannabis and individual cannabinoids in particular, and to determine their safety and efficacy.
Evidence against the use of cannabis in diabetes
The use of cannabis, particularly its psychoactive component THC, along with endogenous analogues such as anandamide that activate central CB1 receptors, has been linked to increased appetite and subsequent weight gain in animal studies. This effect is beneficial in situations such as cachexia or during chemotherapy, but is problematic for people with type 2 diabetes, where obesity can worsen insulin resistance.
On the other hand, hyperactivation of the CB1 receptor of the endocannabinoid system in peripheral tissues is linked to obesity and metabolic syndrome. Thus, cannabis administration could increase fat production and insulin resistance, complicating diabetes management. Inhibiting peripheral CB1 receptors could be a strategy to mitigate these effects, but more research is still needed.
The case of the drug rimonabant: a cautionary lesson
The drug Rimonabant, a CB1 receptor antagonist, showed benefits in weight reduction and improved metabolic markers, but was withdrawn from the market due to severe neuropsychiatric side effects, linked to suicide. This highlights the importance of targeting peripheral CB1 receptors to avoid risks. Current studies on compounds such as CBD, which modulate the endocannabinoid system without psychoactive effects, such as CBD or cannabidiol, show promise for treating diabetes-related metabolic syndrome.
Evidence supporting the use of cannabinoids in diabetes
Some studies have found that cannabis users are less likely to develop diabetes, despite the fact that cannabis can increase appetite. These findings suggest that cannabis may have a regulatory effect on metabolism, reducing the risk of diabetes.
Cannabinoids are also known to affect various metabolic pathways that influence blood sugar and insulin levels, which may explain why some studies have found that cannabis users have lower fasting insulin levels and lower insulin resistance, which may help prevent diabetes.
Research conducted at Harvard Medical School has found that cannabis can improve insulin sensitivity and lower blood glucose levels.
In particular, CBD, the non-psychoactive compound in cannabis, has shown potential in protecting insulin-producing pancreatic cells, suggesting potential benefits in the management and prevention of diabetes.
Despite these results, it should be noted that in all cases these are preliminary studies, more solid scientific evidence is lacking, and until further studies are carried out, it is not possible to confirm these properties. Patients are advised to consult their specialist doctor before considering using CBD.
Cannabinoids for diabetes: current research
Research on cannabinoids for diabetes is still at a preliminary stage. Some studies suggest that certain cannabinoids may improve glucose regulation and reduce inflammation, but more research is needed to fully understand their effects and determine their safety and efficacy in the treatment of diabetes. Here is a review of current research:
CBD and its promising role in diabetes
CBD or cannabidiol shows potential in diabetes management by improving insulin sensitivity and reducing inflammation, although more research is needed to confirm its benefits and safety.
Detail: Studies on CBD for diabetes
In a 2006 animal study, it was shown that administration of CBD at a dose of 5 mg/kg daily significantly reduced the incidence of hereditary diabetes in a mouse model. In this study, 86% of the control group developed diabetes, compared to only 30% of the CBD-treated mice, indicating not only a lower incidence, but also a delayed onset of the disease.
Other studies corroborated these findings. In addition, in a mouse model of autoimmune (type 1) diabetes, the control animals developed diabetes by week 17, while most of the CBD-treated mice remained diabetes-free until week 24.
Therapeutic efficacy of tetrahydrocannabivarin (THCV)
THCV is a cannabinoid found in small amounts in cannabis, with the ability to reduce appetite and alleviate inflammation and oxidative stress. On a more technical level, it acts as a CB1 receptor antagonist and CB2 receptor agonist. Preliminary studies have shown that THCV, even at low doses, can decrease food intake and body weight. In addition, research in 2013 found that THCV improves glucose tolerance and insulin sensitivity, suggesting its potential in the treatment of metabolic syndrome and type 2 diabetes. These benefits were confirmed in a subsequent clinical trial with diabetic patients, improving their blood sugar control.
THCA and its potential for diabetes
In 2020, a study in animal models on the effects of tetrahydrocannabinolic acid (THCA), the non-psychoactive precursor of THC, found that THCA significantly reduced obesity-induced fat mass and body weight gain. In addition, THCA improved glucose tolerance and insulin resistance, and prevented liver problems such as steatosis. Being a partial modulator of PPARγ receptors, THCA showed less activity on fat formation compared to other drugs such as rosiglitazone (oral antidiabetic), highlighting its potential in the treatment of diabetes. These results suggest the potential of THCA in the treatment of diabetes, although further research is warranted.
Ultimately, key cannabinoids, including CBD, THCV and THCA, as well as agents that inhibit peripheral CB1 receptors or activate CB2 receptors, and possibly GPR55 and GPR119 receptor agonists, are at the forefront of preclinical research. These compounds show significant therapeutic potential, highlighting the growing interest in harnessing their mechanisms for the management of diabetes.
Conclusions on the use of cannabis and CBD in diabetes
Neither cannabis nor CBD is currently an approved medicine for diabetes, and if you have diabetes, you should consult a specialist before taking CBD or cannabis, in order to get professional advice and to monitor doses and any possible interactions and effects.
What has been described here is that there are promising epidemiological findings and emerging clinical evidence on the potential of cannabis and its components for diabetes. Hopefully, in the coming years we will have more information and studies to deepen our understanding of the potential of cannabinoids to improve diabetes care.
The information in this article has been adapted from Cannabiscientia’s Principles of Clinical Cannabinology handbook, by Viola Brugnatelli, Fabio Turco and Prohibition Partners. It is a guide to medical cannabis and cannabinoids for healthcare professionals that covers the European medical cannabis landscape in depth. The second edition is now available.
Note: This article is for information only and is not prescriptive; it is not intended to prevent, diagnose or treat any disease. Its content may complement, but must never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. New relevant scientific evidence may have emerged since the date of publication. Consult your doctor before using CBD. The therapeutic approach must always be personalised and depends on professional assessment.
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Frequently asked questions
How does cannabis affect diabetes?
The effects of cannabis on diabetes are not linked solely to its best-known component, tetrahydrocannabinol (THC), but also to other types of cannabinoids with a range of different functions.
Can I take or use CBD if I have diabetes?
According to current experimental results, CBD may be of great value in treating diabetes and its complications. However, although CBD is a fairly safe compound, its efficacy in diabetes has yet to be fully demonstrated. People with diabetes should not use CBD without professional advice, especially if they are taking any kind of medication. In these cases, cannabis and its derivatives, such as CBD, can cause side effects and interact with medicines. In short, although CBD is a safe compound, its use is not recommended without professional advice and supervision.
Can CBD treat or improve diabetes?
CBD shows potential in the treatment of diabetes. CBD may improve pancreatic islet function, reduce pancreatic inflammation and improve insulin resistance. For diabetic complications, CBD not only has a preventive effect but also has therapeutic value for existing diabetic complications, and it improves the function of target organs. However, these results are still preliminary and need to be confirmed by larger randomised controlled trials (RCTs). So, for now, there are other, more effective first-choice treatments for diabetes. It is essential to consult your specialist doctor for guidance on the most suitable treatment before using CBD.
Does cannabis affect blood sugar levels?
Cannabis use can influence the regulation of blood sugar levels. Both THC and CBD have shown potential to improve insulin sensitivity, lower blood glucose and regulate sugar levels, although these effects have not yet been fully confirmed. What these results do tell us is that using cannabis and products such as CBD oil may interact with other diabetes medicines intended to control blood sugar. In addition, smoking cannabis can increase appetite, leading to eating more food. It is also worth bearing in mind that with high doses of cannabis, or in people who are not used to it, dizziness can occur because of its vasodilating effect, which is not necessarily directly related to a drop in blood sugar.
Does CBD interact with other diabetes medicines?
Interactions between CBD and certain medicines have been described, and cannabis and CBD may interact with the drugs used to treat diabetes, which could affect their efficacy and increase the risk of side effects. If you take medication, it is essential to consult your specialist doctor to assess the risks and benefits and to adjust medication doses if you decide to start using CBD regularly.
Can cannabis make diabetes worse?
Cannabis use, especially smoking cannabis, can make type 2 diabetes worse in several ways. In general, smoking is devastating for cardiovascular and lung health, which aggravates diabetes. In the short term, cannabis can increase appetite and lead to weight gain, making diabetes harder to control. As for products such as CBD oils, they do not have the drawbacks of smoking, but they are not an approved medicine for diabetes either, and in any case their use is only advisable on a specialist’s advice.
