I love California. This November, Californians will have the opportunity to vote on a measure that would legalize marijuana use and sale in the state. Adults over the age of 21 would be allowed to carry up to an ounce of marijuana, and they would be allowed to cultivate for personal usage up to 25 square feet of cannabis plants. As of April 2009, 56% of Californians surveyed supported the legalization and taxation of pot.
Let me be clear: I like this idea because I think it’s silly to have so much of our criminal justice system tied up with drug charges, and because I giggle at the absurdity of the fact that our state government is essentially saying, “Well, if you can’t beat ‘em…”
In other words, my reasons for liking this proposal, and for liking California, have nothing to do with the drug itself. In fact, pot itself is a big open question for me– namely:
Can a diabetic smoke pot?
I don’t mean “can” here as a verb of possibility or survivability. What I mean is– is it a good idea for a type 1 diabetic to smoke pot? How does marijuana affect blood sugar control and management, in terms of both behavior and biology?
Lacking any personal experience in the matter, I first turn to the internet to answer these questions.
The first thing I note: many other people are wondering the same thing. Rarely does Google pre-fill queries I have about diabetes, but this one Google is all over: “marijuana diabetes,” “marijuana diabetes type 1,” “marijuana diabetes type 2,” “marijuana diabetes treatment,” and so on.
The results of these queries are full of accounts from people with the personal experience I don’t have. There are apparently many message boards, either diabetes-focused or pot-focused, that have touched on the question of whether it’s OK for diabetics to smoke pot.
The behavioral effects seem widely agreed upon– pot tends to warp the user’s judgement, and tends to bring on “the munchies,” neither of which is particularly good for diabetics. But, notably, neither is insurmountable for diabetics or the non-diabetic pot smoker, and, frankly, neither is all that different for blood glucose control from the effects or being at a party where everyone is eating and the lone diabetic is too busy to pay close attention to her diabetes.
But the biological effects are much more unclear. Personal experience reported on forums here is nearly useless, as most people, especially people under the influence, are poor judges of the exact patterning of biological or metabolic changes. Some people claim pot use lowers blood glucose and HbA1c (see bob1234 here), others claim it raises blood sugars, and no one is impartial. (Unsurprisingly, everyone who identifies as a pot-smoking diabetic in these forums thinks it’s just fiiiiine.)
Medical research, unfortunately, does not prove to be much help either here; there are plenty of papers on the blood glucose control of substance-using diabetics, especially teens, but asking “How well do pot-smokers manage their diabetes?” is very different from asking, “What, independent of behavior and emotion, does pot do in a diabetic?”
So, I conclude: I don’t know if I could or would smoke pot, even if it were legal.
Of course, if marijuana use is legalized in California, there will likely be a sudden increase in the amount of available scientific research on the subject, complete with double-blind tests and molecular analyses of the effects of marijuana on all sorts of people, including diabetics. (Can’t you just see it now? Every grad student in California will suddenly decide, gee, I want to write my thesis on how pot affects my depression/angst/ability to parse 19th century English literature…)
Any type 1 diabetics out there with experience want to weigh in?
Thanks, this is an important topic, too little covered, as you say. My two cents follow. The question in your title reads a lot like “Can a diabetic drink alcohol?” Many people suffer under the illusion that it is forbidden for diabetics to drink alcohol. Every doctor I have ever talked to has said that it’s OK, only that beer and wine RAISE bg levels; distilled drinks may LOWER bg levels. One has to take that into consideration, as well as the fact that alcohol can impair judgment, etc. I don’t see why the exact same reasoning would not apply to marijuana. And this is in fact what every doctor I have talked to about marijuana says. (Endocrinologists also happen to be interested in the mechanism by which pot smoking causes hunger; one hypothesis is that it increases insulin production.) In general, I think one should avoid framing issues as “Can a diabetic do X” where X is something like “putting white sugar in tea” or “eating eggs” or “drinking alcohol” or “smoking marijuana”. The question is: what risks associated with this activity are uniquely worse for diabetics, and how bad are they? It turns out that smoking tobacco is deadly for diabetics (and for everyone else), and so that is surely too great a risk. But NONE of the bad things about tobacco apply to marijuana, and there is nothing uniquely bad about marijuana for diabetics. I will not here get into the myriad possible health benefits of marijuana for diabetics, such as the neuroprotective effects of cannibidiol, or the possible pain therapies for diabetic neuropathy. But either there is no yes/no answer to the question, the answer is: “yes, a diabetic can smoke pot so long as she takes into consideration that…”
MRJ- interesting comment… in particular the hypothesis that marijuana increases insulin production. Also, I was under the impression that wine doesn’t raise BG the way beer does.
I don’t have personal experience in it, but I would caution that there’s already an issue going on with people needing organ transplants who are turned down because of marijuana use (even medical marijuana).
Since diabetes is the #1 cause of kidney failure (which leads to a need for a kidney transplant), that would be a good reason to avoid the use of marijuana.
Allison: could you say more about “an issue going on with people needing organ transplants who are turned down because of marijuana use– even medical marijuana”. What is the issue?
Also, I disagree with the argument in your final paragraph. All that follows from diabetes being the #1 cause of kidney failure is that diabetics who are suffering from diabetic kidney disease (a small fraction of those who suffer from diabetes) and who are candidates for kidney transplants (a small fraction of those who suffer from diabetic kidney disease) should consider not smoking marijuana if they also have whatever issue you are talking about that complicates marijuana users from getting a kidney transplant.
Jessica: I was simply referring to the fact that wine has carbohydrate, and so will raise bg on that score. I think you might be right that on average wine does so less than beer. A glass of red wine has about 5 grams carbohydrate; a Guinness has about 10 grams (all these vary depending on a variety of factors).
Allison: I was simply referring to the fact that wine has carbohydrate, and so can be expected to increase bg on that score. You are probably right about wine doing so less than beer.On average a glass of red wine has just over 5 grams carbohydrate; and Guinness just over 10 grams, and so diabetics who have one of these will have to adjust insulin dosages accordingly. Pot smoking does not contain carbohydrate, and I do not believe (based on personal experience) that it has a direct affect on raising or lowering bg. Here is a link to an article including the theory that marijuana reduces bg: http://www3.interscience.wiley.com/journal/119693693/abstract?CRETRY=1&SRETRY=0 But here is a link to a study claiming there is no effect: ajp.psychiatryonline.org/cgi/reprint/133/2/220.pdf
Dude, of course a diabetic can smoke up – everyone can.
Sorry, MRJ, but I’m with Allison on this one– @Allison, that is a very good point, and not one I had thought of. I don’t intend to ever reach the point where I need a kidney transplant, but it is important to recognize that for any organ transplant or life-saving operation with contended resources, I already have ten strikes against me because I’m a diabetic. Why bother performing a costly operation if statistically I have an x% chance of dying prematurely anyways because of poorly maintained diabetes? At this point, a reasonable argument could be made that I have very well-maintained diabetes, and therefore I should be an eligible patient. However, if I’m a diabetic and I am found to smoke marijuana… I wouldn’t want to be the doctor making that call. All theoretical, of course, but worth considering nonetheless.
My information regarding the leading causes of kidney failure comes from the American Diabetes Association website, which says:
“Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.”
See http://www.diabetes.org/diabetes-basics/diabetes-statistics/
(Hypertension is the second leading cause, and of course that’s another common diabetic complication).
The issue about smoking marijuana, combined w/ diabetes and transplants, is this:
“Hospital transplant programs, wanting to ensure the best possible outcome for each transplant and to make optimum use of the limited number of organs available, have strict standards about drug use and smoking in determining who is eligible for a transplant list.”
(From this story: http://articles.latimes.com/2008/may/19/nation/na-transplant19)
I received a kidney and pancreas in 2005; transplant programs are quite strict about a lot of things. For example, if I had skipped dialysis sessions, I would have been removed from the active transplant waiting list, which makes sense when you have over 108,000 people currently waiting for some kind of organ. Why give it to someone who won’t go to their dialysis sessions, and why risk smoking MJ, which might or might not interfere with the transplanted organ or interact very badly w/ the anti-rejection medication? Sorry, I can’t sign up to be the guinea pig for that medical study.
Im 15 and im diabetic. I like to have a nice blaze up on the weekend with my mates, i occasionally drink aswell, I had it all under control but recently the munchies have been hitting me badly and it raises my blood sugars to around 21.0-23.0. Any suggestions on how I can keep better control of my blood sugar and still smoke weed which I enjoy? thanks
Hi Lockerzz,
I don’t suppose, “Hey, maybe you shouldn’t do that,” is the answer you’re looking for?
I do not have any personal experience with managing blood sugar when smoking pot– but I do unfortunately have personal experience with out of control blood sugars during my teen years. So I know first hand– it’s dangerous, and it does matter; I have cataracts from poor control for a few years. Please be careful, especially when smoking and drinking. Is there any doctor– primary care, endocrinologist, nutritionist even– who you would feel comfortable speaking to? Who would keep things confidential? If so, I would suggest asking him or her for best-practice advice. If not, maybe enlisting a responsible friend to be a “designated driver” for you diabetes during the occasional excursion?
Again, I am only guessing here; if anyone else has personal experience, please, do add your two cents in these comments. @MRJ? Thoughts?