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 Researchers surveyed 450 patients with type 1 diabetes in Colorado,
where cannabis is legal for medical and recreational use. Overall,
30 percent of the participants used cannabis.
Compared to nonusers, cannabis users had about twice the risk of
experiencing a serious complication known as diabetic ketoacidosis,
which develops when blood sugar is elevated for too long and the
body produces high levels of acids known as ketones. Left untreated,
ketoacidosis can lead to severe dehydration, swelling in the brain,
coma and death.
Some previous research suggests that for people with type 2 diabetes
- the more common form linked to obesity - cannabis may make it
easier to use the hormone insulin to convert foods into energy and
maintain lower blood sugar levels, researchers note in JAMA Internal
Medicine. But less is known about the impact of cannabis on people
with type 1 diabetes, the less common form that typically develops
in childhood and is caused by a breakdown in the body's immune
system.
The study wasn't a controlled experiment designed to prove whether
or how cannabis might directly cause ketoacidosis. But it's possible
that vomiting caused by long-term cannabis use might lead to
dehydration that can increase ketones and lead to ketoacidosis in
people with type 1 diabetes, said senior study author Dr. Viral Shah
of the Barbara Davis Center for Diabetes at the University of
Colorado Anschutz Medical Campus in Aurora.
"Elevated ketones may be life threatening if not treated on time,
and patients can (have) nausea, vomiting, abdominal pain, shortness
of breath and rarely confusion or altered consciousness," Shah said
by email. "Diabetic ketoacidosis is an emergency and patient with
diabetes should go to emergency room if they have symptoms."
The condition is typically treated with intravenous fluids to
hydrate the body and replenish electrolytes and insulin to control
blood sugar.
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The study participants typically had poorly controlled diabetes,
based on blood tests of hemoglobin A1c (HbA1c), which reflect
average blood sugar levels over about three months. People with type
1 diabetes are generally advised to keep their HbA1c levels below
6.5 percent.
Participants who used cannabis in the study had average A1c readings
of 8.4 percent, representing dangerously elevated blood sugar that
can increase the risk of heart attacks, strokes, kidney failure,
blindness, amputations and death.
Non-cannabis users had average A1c readings of 7.6 percent, still
higher than ideal but not as dangerous as the levels for people who
used marijuana.
More research is needed to understand the different impact of
cannabis on people with different types of diabetes, said Dr.
Annemarie Hennessy, dean of the School of Medicine at Western Sydney
University in Australia.
"In type 1, individuals don't make insulin and in type 2, it mostly
doesn't work well," Hennessy, who wasn't involved in the study, said
by email.
Patients should still err on the side of caution and avoid cannabis,
Hennessy advised.
"Why cannabis would increase the likelihood of diabetic ketoacidosis
is unknown," Hennessy said. "But we have also shown that in the
presence of cannabis, the diabetic ketoacidosis is harder to
diagnose, and therefore it may be missed, with deadly consequences."
SOURCE: http://bit.ly/2SNqw07 JAMA Internal Medicine, online
November 5, 2018.
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