Cannabis — also known as marijuana — has become increasingly popular, with many states making it legal or reducing penalties for medical and recreational cannabis use. In fact, cannabis use in people with type 1 or type 2 diabetes rose 340 percent — from 1.7 percent to 5.8 percent — between 2005 and 2018.

Although cannabis has been found to have health benefits for some people — such as reducing inflammation, relieving pain, and managing nausea — it can also have side effects. Some of these unwanted effects can be especially harmful for people with type 1 diabetes.

If you have type 1 diabetes and use cannabis — or are thinking about trying it — it’s important to learn about potential risks and how they relate to your condition. Here are some topics that you or a loved one with type 1 diabetes can discuss in more detail with your endocrinologist and health care team.

What Exactly Is Cannabis?

Cannabis is a drug that comes from the cannabis plant. Medical marijuana, also known as medical cannabis, is used for medicinal purposes and is usually derived from the cannabis sativa plant. Cannabis indica is the other main strain of marijuana.

Marijuana has two main active compounds, or cannabinoids — delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound that causes intoxication or euphoria, which is the feeling of being high.

Marijuana is available in a variety of forms. Cannabis products include edible forms such as lozenges, gummies, and capsules. Cartridge and dried plant forms can be vaporized (vaped) or smoked. Tinctures, topicals (products applied to skin), and patches allow active ingredients to be absorbed through the skin.

Cannabis, Type 1 Diabetes, and Diabetic Ketoacidosis

In people living with type 1 diabetes, cannabis has been shown to have negative effects, some of which may be serious. If you use marijuana either medically or recreationally and have type 1 diabetes, it’s important to talk openly with your health care providers about using cannabis so that you have a clear understanding of the risks.

One 2020 study found that moderate cannabis use was associated with a 2.5-fold increase in the odds of diabetic ketoacidosis (DKA) in adults with type 1 diabetes. Diabetic ketoacidosis occurs when the body lacks enough insulin to provide blood sugar to cells. This causes a process in which acids called ketones build up in the body.

DKA can be an early sign of type 1 diabetes, occurring before diagnosis. DKA is a serious condition that may be life-threatening. Symptoms include:

• Frequent urination
• Extreme thirst
• Fast and deep breathing
• Headache
• Stiff or achy muscles
• Stomach pain, nausea, and vomiting
• Fatigue
• Breath that smells like acetone (nail-polish remover)

Diabetic ketoacidosis can also occur with use of alcohol and certain illegal substances. Importantly, a person can develop DKA even if they haven’t used cannabis, alcohol, or illegal substances, particularly if they miss doses of insulin or have been sick and are eating and drinking irregularly. Some medications can also cause DKA.

If you experience any DKA symptoms, be sure to contact your doctor right away or seek emergency care.

Hyperglycemic Ketosis-Cannabis Hyperemesis Syndrome

Some research has shown that people with type 1 diabetes who are cannabis users have an increased risk of developing hyperglycemic ketosis-cannabis hyperemesis syndrome (HK-CHS), which can mimic DKA. This syndrome is characterized by nausea in the morning that develops into severe vomiting, followed by:

• Ketosis — The body burns stored fat instead of blood glucose (blood sugar) for energy.
• Alkalosis — Blood is too alkaline, with too much base and not enough acid.
• Hyperglycemia — Blood sugar levels are too high.

HK-CHS requires medical care and may produce symptoms that continue for days or weeks. Sometimes, the syndrome is confused with DKA and not treated properly.

Cannabis and Increased Insulin Sensitivity

Some people with type 1 diabetes who use marijuana may become more sensitive to insulin. When this happens, either low or high blood sugar may feel more intense. Marijuana can cause sensations that feel like symptoms of hypoglycemia (low blood sugar).

Cannabis can cause irregular blood sugar levels because it slows the time it takes for food to move from the stomach to the small intestine. If you use cannabis and have type 1 diabetes, it’s essential to monitor your blood glucose levels regularly. Also, make sure you’re with someone who’s sober and can recognize the signs of low or high blood sugar. Marijuana can affect everyone differently, and the many types of cannabis may produce different effects.

Marijuana and Impaired Cognitive Function

Using cannabis can cause short-term cognitive problems — that means it may impair thinking, decision-making, judgment, memory, and attention. Cognitive problems from marijuana may interfere with your glucose monitoring and diabetes management. Research has shown that people with type 1 diabetes who used cannabis recreationally may have difficulty with diabetes self-management and have poorer blood sugar control.

The cognitive effects of cannabis could also lead you to miss insulin doses, resulting in hyperglycemia or diabetic ketoacidosis. Your blood sugar levels could rise or drop too much if you change the amount of food you usually eat. You may not recognize the symptoms of hyperglycemia or hypoglycemia and be able to treat it properly.

Other General Side Effects of Cannabis

Whether or not you have type 1 diabetes, marijuana use can cause side effects including:

• Headache
• Dizziness or lightheadedness
• Drowsiness or fatigue
• Disorientation
• Nausea and vomiting
• Increased appetite
• Increased heart rate

Cannabis can also make mental health symptoms worse in people with conditions such as bipolar disorder or depression. It may also have negative interactions with medications. If you take any treatment for conditions besides type 1 diabetes, talk to your doctor about the risks of using cannabis.

Potential Benefits of Cannabis in People With Type 1 Diabetes

Although research is limited, cannabis may be beneficial for some people with type 1 diabetes. However, much of the research has been conducted on animals or in small human studies, so more extensive research is needed to fully understand these effects. Potential benefits include protecting against diabetic retinopathy (damage to the blood vessels in the retina) and reducing neuropathy (nerve damage) symptoms, which can include pain, numbness, tingling, or weakness.

Before trying cannabis, it’s important to get medical advice from your diabetes care team so that you have a good understanding of the potential risks and benefits.

Legal Restrictions on Cannabis

Many states in the U.S. have legalized medical marijuana. In these states, cannabis may be distributed by state-certified dispensaries that require official medical marijuana identification cards you get after consulting a doctor. Some states allow individuals to grow their own medical marijuana. State cannabis laws vary considerably and typically limit how much marijuana can be legally possessed, sold, or grown.

Your doctor can advise you on your state’s regulation of medical marijuana if it has been legalized. You can find more information about marijuana laws in your state through the Marijuana Policy Project. It’s also important to know that cannabis is still considered an illegal drug on the federal (national) level in the United States.

Precautions for Using Cannabis if You Have Type 1 Diabetes

If you have diabetes and are using or thinking of trying cannabis, follow these tips to help you stay safe:

• Be as informed as possible about potential effects.
• Choose a safe environment.
• Have someone with you the first time you use cannabis.
• Carry something identifying you as having type 1 diabetes, such as a medical ID bracelet.
• Ensure that at least one person present knows what to do in an emergency.

What About CBD and Type 1 Diabetes?

Although cannabis usually refers to marijuana products that have THC, the other active compound, CBD, is also available in numerous products that are consumed orally or used topically. Unlike THC, CBD doesn’t cause sensations of being high. However, some CBD products may contain THC, which does cause intoxication.

Many people report positive effects from CBD, as one myT1Dmember described. “CBD gummies without THC can help with stomach issues. I’ve been using CBD gummies for about 5 years,” they said. “They changed my life.”

According to the American Diabetes Association, CBD has not shown any clear benefits for people with type 1 diabetes. Some research has indicated that it may hold back immune system function and increase pressure in the eye that could worsen glaucoma. CBD may also interact with some medications.

CBD products are readily available, but only those that are produced from the hemp plant (which is related to cannabis) are legal in the United States.

Be sure to talk with your health care provider about the pros and cons of using cannabis or CBD if you have type 1 diabetes. They can offer guidance tailored to your particular situation.

Talk to Others Who Understand

On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Have you talked with your doctor about cannabis? Share your experience in the comments below, or start a conversation by posting on your Activities page.