Cannabis + Diabetes: What You Should Know

Weed, pot, flower, Mary Jane and grass. As the most widely used, federally illegal drug, cannabis has many street names. Compared to 30 years ago, an estimated 17.7 million people use marijuana on a daily or almost-daily basis—a 15x increase.

More states have passed laws allowing adults aged 21 and over to use marijuana for fun. According to Cannigma, even though cannabis is still illegal under federal law, many states have approved its medical and recreational use. 

A total of 41 states, along with the District of Columbia and Puerto Rico, have programs for medical marijuana. Out of these states, 26 have also made cannabis decriminalized.

 If you live with diabetes and reside in one of these states, this guide explains what you should know about using cannabis. 

What is cannabis?

Cannabis is a plant called cannabis sativa, and it has a chemical called tetrahydrocannabinol (THC) that affects how you think and feel. People can use cannabis by smoking it, vaping it or eating it in food. Nowadays, it can even be grown to have higher levels of THC, which makes its effects even stronger.

If you’re new to using marijuana while living with diabetes, there are a few things you should know right away:

• Marijuana affects your mind: THC is a chemical found in marijuana that changes how your brain works and how it talks to the rest of your body. Because of this, most places where marijuana is legal set the minimum age for using it for fun at 21 years old.
• THC is different from cannabidiol (CBD): CBD is a chemical found in the cannabis plant. Unlike THC, which can change how your mind works, CBD doesn’t have that effect. It is derived from the plant and is sometimes included in food, drinks, beauty products and other items you can buy without a prescription.
• CBD isn’t regulated: CBD products aren’t officially checked or approved by the Food and Drug Administration (FDA). Right now, scientists are studying how CBD might help with conditions such as inflammation, pain and sleep.

Everyone reacts to marijuana differently 

Avoid using marijuana alone, especially if it’s your first time or if you’re not sure how it will affect you. It’s hard to anticipate how it will affect each person.

If you choose to use marijuana for fun or health reasons, make sure you’re in a safe place with people you trust. THC, the main ingredient in marijuana, can affect how you think and feel in different ways. It’s important to stay informed and make responsible choices to ensure a good experience.

Remember, every time you use marijuana, your body and mind might react differently. Factors such as your mood, your blood sugar and how much you use can all influence these reactions. By understanding these differences, you can make smart decisions for your body and prepare accordingly.

Other things that can impact your reaction to marijuana include:

• The strain (type) of marijuana
• The amount you consume
• How you consume it (smoking, vaping, eating, drinking, etc.)
• Your mental state at the time of consumption
• Your ongoing mental chemical balance
• Other substances or medications that might be in your body at the same time, including how much insulin you have from long-lasting (basal) insulin or from a recent dose of fast-acting (bolus) insulin, which you might take for a meal, snack or to lower high blood sugar levels

How does it feel to use marijuana?

Marijuana can affect people in different ways. Just because one person feels a certain way after using it doesn’t mean you will. How marijuana impacts you depends on your own body’s chemistry—it’s important to remember that everyone reacts differently.

A few hours after using marijuana, you might feel:

• Relaxed, mellow or calm
• Euphoric, happy or creative
• Sleepy or lazy, like your body is heavy
• Shaky or on edge (similar to the feeling of low blood sugar)
• Talkative with wandering thoughts
• Quiet with mental chatter muted
• Anxious or paranoid, without the ability to calm yourself
• Thirsty, hungry or unable to control your appetite
• Nauseated and dizzy

How long does marijuana affect you?

Marijuana can stay in your body for three to 30 days, depending on how often you use it and the type of marijuana. This means you might test positive on a drug test for up to a month after using it. Using marijuana can also change how your brain works.

After using it, some people feel more relaxed and calm, while others might feel more anxious or have trouble thinking clearly. Marijuana’s impact on your system can change depending on the method of consumption and how much is consumed. 

How smoking marijuana could impact your body with diabetes

There are two main ways to use marijuana: by inhaling it or by eating it in foods (called edibles).

When you inhale marijuana, whether by smoking or using a vape, you feel the effects pretty quickly. They start working almost right away and usually reach their strongest point within a few minutes to an hour.

Inhaled marijuana can also affect your blood sugar levels quickly. Some people find that their blood sugar drops almost immediately, while others experience a spike.

The effects of inhaled marijuana can last for hours, and some people might feel “brain fog” that can stick around for up to three days. How strong the effects are can depend on how you use it, how much you take and the strain.

It’s important to remember that smoking anything can be bad for your lungs because of the harmful chemicals that come with it.

How edible marijuana could impact your body with diabetes

When you think of edible marijuana, you probably think of pot brownies. It’s a movie trope for a reason. Marijuana can be infused into fats like butter or oil, allowing the THC (the active component) to be absorbed effectively. This infused fat can then be added to a variety of foods, candies or drinks to create what we call “edibles.”

When you eat marijuana, the effects take longer to kick in compared to smoking. Usually, you might start feeling high anywhere from 30 minutes to two hours after you consume it. The experience can feel more intense and last longer—typically between two and eight hours.

Several factors can influence how long you feel the effects. These include the type of edible (like brownies versus gummies), the strain of marijuana used, how much you eat and your own metabolism. If you decide to try edibles, it’s important to start with a small amount and be mindful of how much THC you’re consuming.

Shop for edibles responsibly

If you’re buying edibles from a licensed dispensary, they’ll usually have clear labels showing how much marijuana is in each serving, typically around 10 mg of THC. However, if you get edibles from somewhere else, the strength can vary greatly, and they may not provide nutrition information, such as the amounts of carbohydrates, proteins or fats, which all impact blood sugar levels.

Remember, even though edibles are tasty, they are still food. If you need to manage your insulin levels, make sure to account for the carbs in the edible. Additionally, marijuana can affect insulin sensitivity, so you might need a lower dose than you usually do. Stay informed and make safe choices!

What should people with diabetes expect when they use marijuana?

Since marijuana impacts how your brain operates, it should be planned for when managing a chronic illness like diabetes, where inattention can cause immediate and harmful side effects. 

If you are consuming marijuana for the first time, here are some diabetes management tips to consider before you use it:

• Don’t use marijuana alone: Make sure you are with someone you trust who knows that you have diabetes, knows how to recognize the signs of low and high blood sugar, knows how to administer glucagon and pledges to remain sober enough to help you if needed.
• Check your levels first: Know your starting blood sugar and how much insulin is in your system—aka how much insulin you have on board (IOB).
• Pay attention to your insulin sensitivity factor (ISF): Marijuana makes some people more sensitive to insulin, which can make a high or low blood sugar level feel more severe.
• Beware of phantom lows: Using marijuana can sometimes make you feel like your blood sugar is low, so it’s important to check your blood sugar regularly. You can do this with a continuous glucose monitor (CGM) or a blood glucose meter (BGM) to check your blood sugar levels often. With phantom lows, you might think your body is telling you that your blood sugar is low, but that feeling could mean something else.
• Keep your low snacks handy: Have fast-acting glucose (like glucose powders, gels, gummies, etc.) and glucagon on hand in case of low blood sugar. Ensure those with you know what to do in the event of a severe low.
• Start slow: Marijuana affects everyone differently. Different strains have a different impact, too. Start very slowly, get to know how marijuana impacts your system, and don’t assume that just because you’ve tried it once or a few times, it will always affect you in the same way.

Dose your insulin carefully with “the munchies”

When using marijuana, it’s important to be mindful of how it can affect your appetite. Many people experience “the munchies,” which can lead to increased food intake. To manage this, it’s a good idea to plan, especially if you need to monitor your insulin levels.

Before you consume marijuana, think about what snacks you want to have handy. It can be really helpful to prepare your snacks in advance and write down their carbohydrate counts along with the amount of insulin you’ll need for each type of food. You might want to keep this information on a sticky note or in your phone so you can easily reference it when needed.

Another useful tip is to consider the snacks you have on hand. Instead of keeping high-carb snacks like chips or candy nearby, you might opt for healthier options like apples or carrots. These choices can help you satisfy your cravings without going overboard on carbs.

A few anonymous community members shared that:

• “When I smoke, my blood glucose ends up going high because I get the munchies and eat everything.”
• “I get what I like to call the ‘gradual munchies.’ I just sort of slowly snack on everything over a long period of time, and since I never eat more than a handful of something at once, I never properly carb-count or dose the right amount of insulin. My blood glucose always ends up going high.”

It’s common but manageable, especially if you smoke with trusted people or those who can look out for you. By planning and making smart choices, you can enjoy your experience safely while also protecting your health! 

Talk to your health care provider about your marijuana use

We know this can feel scary, especially if you think you’ll get in trouble for speaking up about it.

But your health care provider—especially the one or team you see for your diabetes care—can help you develop a plan for when you use marijuana. They can assist you in recognizing blood sugar patterns related to consumption and create a plan for insulin dosing when you have THC in your system, as your body’s insulin sensitivity may vary.

An anonymous community member was surprised when talking to her endocrinologist about her marijuana use: “She’s actually been non-judgmental and is just here to help me from a medical perspective. Does she prefer I smoke? No. But she helps me with a plan to keep me safe when I do.”

Tips + stories from the diabetes community about marijuana use

In addition to the guidelines mentioned above, here’s some more anonymous advice from the diabetes community on using marijuana responsibly:

• “Be aware of altered perception.” Like alcohol, if you’re under the influence of a mind-altering substance, you may not be able to recognize if you’re feeling low or high in terms of your blood glucose levels. Know that your general perception may be inaccurate or faulty.
• Be aware of when your body is deceiving you. “I thought I was dying. I was convinced I needed an ambulance. I ate like three McChickens without bolusing and woke up at 450 mg/dL.”
• Watch your blood sugar extremely closely. “I’m lucky to have a CGM, so I always watch my blood sugar closely when I’m high. On two separate occasions, I was around 150 mg/dL and moving down slightly, but I felt really low—shaky, vision blurring, like I was about to pass out. The first time, I was able to stay conscious, but the second time, I did pass out and hit the ground pretty hard. Once I came to a few seconds later—even though I only had a unit of insulin on board—my blood sugar was falling fast. I ended up having to drink an entire carton of juice because I ended up around 70 mg/dL with double down arrows. It seems only to happen when I smoke a little too much. It’s weird, though, that my body will act like I’m super low even though I’m not. It wasn’t just feeling low—my body acted like I was that low.”
• Check your blood sugar levels frequently. “Because of altered perception, you should check your blood sugar at regular intervals to be sure you’re in a safe range, and ensure you’re with people who know how to help if you experience extremely high or low blood sugars while high.”
• Consider adjusting your pump settings. “Smoking always makes my blood sugar go low naturally. I start smoking, and then it just slowly creeps down, so I always have to be careful to either suspend my pump or have some sugar.”
• Be mindful but enjoy. “I am always so scared to crash low after drinking that I never really have fun because I get so worried. There is no sugar or carbs in smoke, so you don’t get that effect of going really high, then crashing back down later. I prefer smoking to drinking because I actually feel safer and more in control of my type 1 diabetes (T1D).”

Using marijuana is your decision alone

It’s important to always pay attention to your surroundings and how your body feels, especially when using any substances. If you have diabetes, take extra steps to stay safe and manage your health effectively.

Always remember that you are in charge of your choices—don’t let anyone pressure you into trying something if it doesn’t feel right for you. Trust yourself to make the best decisions for your well-being. And if you’re looking to connect with a community that understands what it’s like to live with diabetes, join our apps.

Editor’s Note: Beyond Type 1 does not encourage any illegal activities. It is important to note that marijuana possession and use remain offenses under United States federal law, as well as in many other countries. The information in this article is intended to assist individuals with diabetes who choose to use marijuana, ensuring they do so as safely as possible.