You probably don’t have to look farther than your local drugstore or beauty product supplier to know CBD has taken a starring role in everything from sparkling water and gummies to tincture oils and lotions. Some may even say that CBD is the “it” ingredient of this day and age.
You’ve probably also heard that CBD — which is an abbreviation for cannabidiol — can help with stress, anxiety, and pain. “When people are in pain, they have a stress response, which causes an increase in cortisol and an increase in blood sugar,” says Veronica J. Brady, PhD, CDE, a registered nurse and an assistant professor at the Cizik School of Nursing at the University of Texas in Houston. Relieving pain can help alleviate the stress response and improve blood sugar levels, as well as improve sleep, she adds.
If you’re managing type 2 diabetes, it’s natural to be curious about whether CBD might help you manage those symptoms, too, to help stabilize your blood sugar. Some healthcare professionals say CBD may play a role in treating diabetes, but it's important to understand that the only health condition CBD has proved effective for is epilepsy in kids. The jury is unfortunately still out, because of a lack of comprehensive research on CBD and type 2 diabetes.
“We don’t know that THC or CBD exerts an effect on diabetes itself, and that means control of blood sugars,” says Cory Toth, MD, a neurologist at Fraser Health at Burnaby Hospital in British Columbia. He adds that pain relief is the number one reason people with diabetes use CBD and tetrahydrocannabinol (THC), another compound found in cannabis, in Canada. It’s worth noting that CBD does not cause psychoactive effects like THC, its chemical cousin.
Why People With Type 2 Diabetes Are Considering CBD
One thing is for sure about CBD: People with type 2 diabetes are taking an interest in the ingredient as a management tool.
In Nevada, where Dr. Brady used to work as a certified diabetes educator, her patients with type 2 diabetes used CBD for nerve pain. She says patients would use CBD in a tincture or in oils that they rubbed on painful areas, including their feet. Patients could buy CBD at medical marijuana dispensaries, which would offer dosing instructions. “They worried about the impact on their blood sugars,” says Brady.
Ultimately, though, Brady says that her patients reported that CBD reduced their nerve pain and improved their blood sugar. She adds that those people who used CBD oils for nerve pain also reported sleeping better.
Heather Jackson, the founder and board president of Realm of Caring in Colorado Springs, Colorado, a nonprofit that focuses on cannabis research and education, also senses an interest in CBD within the diabetes community. “In general, especially if they’re not well controlled, people are looking at cannabinoid therapy as an alternative, and usually as an adjunct option,” says Jackson, adding that callers have questions about CBD for both blood glucose control and neuropathy pain.
Realm of Caring receives an average of 7,000 inquiries about cannabis a month, Jackson says. The organization keeps a registry of these callers, where they live, and their health conditions. Jackson says that people with type 2 diabetes are not a large percentage of the callers, but they currently have 330 people with diabetes in their database.
Jackson says that Realm of Caring does not offer medical advice, and it does not grow or sell cannabis. Instead, it offers education for clients and doctors about cannabis, based on its ever-growing registry of CBD users, their conditions, side effects, and administration regimen. “We are basically educating,” says Jackson. “We want you to talk to your doctor about the information you receive.”
Scientific Studies on CBD and Type 2 Diabetes, and Barriers to Research
Despite interest among people with type 2 diabetes, large, rigorous studies showing how CBD may affect type 2 diabetes are lacking, says Y. Tony Yang, MPH, a doctor of science in health policy and management and a professor at George Washington University in Washington, DC. Specifically absent are randomized controlled trials, which are the gold standard of medical research, per a June 2016 article in the New England Journal of Medicine.
But early research may suggest the two are worth studying further. For example, a small study published in October 2016 in Diabetes Care in the United Kingdom of 62 people with type 2 diabetes found that CBD did not lower blood glucose. Participants were not on insulin, nor were they on any diabetes drugs, and they were randomly assigned to five different treatment groups for 15 weeks: 100 milligrams (mg) of CBD twice daily; 5 mg of THCV (another chemical in cannabis) twice daily; 5 mg CBD and 5 mg THCV together twice daily; 100 mg CBD and 5 mg of THCV together twice daily; or placebo. According to the authors, THCV (but not CBD) significantly improved blood glucose control.
A Canadian study published in Pain of 37 people with diabetes found that a synthetic cannabinoid called nabilone improved nerve pain. “We also found patients had better sleep measures, so their sleep was more complete. Anxiety levels improved to a smaller amount,” says Dr. Toth, who led the study.
“Pain has a lot of neighbors,” Toth says. “If you have chronic pain, you typically have sleep issues, raised levels of anxiety, and depression. So, we thought nabilone could target some of those important features in those patients [with diabetic nerve pain].” He adds that nabilone is commonly prescribed for pain in Canada.
Other CBD research is still evolving. Some CBD and diabetes studies have been done in rats, which leads to findings that don’t always apply to human health. Other studies have looked more generally at the body’s endocannabinoid system, which sends signals about pain, stress, sleep, and other important functions. Still other studies, including one published in the American Journal of Medicine, have looked at marijuana and diabetes, but not CBD specifically.
So why aren’t there more studies of CBD in people with type 2 diabetes? “One reason is definitely regulatory barriers,” says Dr. Yang. He points to the 1970 U.S. Controlled Substances Act, which classifies cannabis as a Schedule 1 drug with the highest restrictions.
Cannabis itself is difficult to acquire for research studies, says Yang. “It is only available through the National Institute on Drug Abuse,” he adds, which has limited supplies.
“Another issue is funding,” says Yang. “In order to do more research, the National Institutes of Health needs to be more open-minded. And other funders must be willing to spend money.” Currently, 33 states and the District of Columbia allow cannabis for medical use and 11 states allow cannabis for recreational use.
Historically, cannabinoids (a group of chemicals in the cannabis plant) have been lumped together, including CBD, THC, and more than 100 others. In the past decade, growers and manufacturers have been able to isolate CBD, mainly by cultivating industrial hemp that is high in CBD and very low in THC, says Jackson. The 2018 Farm Bill removed industrial hemp from the controlled substances list, clearing the way for more production and research of hemp and thus CBD.
“There have not been a huge amount of clinical studies [of CBD], but most of that relates to how the cannabinoids have been treated as a group,” says Toth. “They’ve been looked down upon. There is stigma around them,” he says.
“It’s difficult for researchers to get access to the quantity, quality, and type of cannabis product necessary to address specific research questions on cannabis use,” says Yang.
Patient Use, the FDA, and the Quality and Quantity of CBD
People with type 2 diabetes aren’t waiting for further study. Brady says her patients were open about using CBD, particularly the younger patients. She says one of her older patients was initially uncomfortable about buying CBD in the same shop that sold marijuana but eventually gave in. Brady adds many people associate CBD with smoking marijuana, but she cautions that CBD and THC are very different chemicals in terms of the way they affect the body.
The U.S. Food and Drug Administration (FDA) approved the first CBD medication in 2018, for treating childhood epilepsy. Currently, there is no other FDA-approved CBD medication for diabetes or any other condition, according to the FDA. In December 2018, the FDA said it was unlawful under the Federal Food, Drug, and Cosmetic Act to sell food or dietary supplements containing CBD. In April 2019, the FDA stated that it’s taking new steps to evaluate cannabis products, and it held a public hearing about cannabis products in May 2019.
“The FDA, for the time being, has focused its limited enforcement resources on removing CBD products that make claims of curing or treating disease, leaving many CBD products for sale,” wrote Pieter Cohen, MD, and Joshua Sharfstein, MD, in a July 2019 perspective in the New England Journal of Medicine. Dr. Cohen is an assistant professor of medicine at Harvard Medical School in Boston, and Dr. Sharfstein oversees the office of public health practice and training at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Of the CBD products on the market, Jackson says it’s often difficult to know what’s inside. A study published November 2017 in the Journal of the American Medical Association found that only 30 percent of CBD products were accurately labeled, with under- and over-labeling of CBD, and some products containing unlisted chemicals such as THC.
At the time this article was written, a spokesperson for the Joslin Diabetes Center in Boston, an affiliate of Harvard Medical School, said that the research center was unable to provide feedback about CBD and type 2 diabetes.
Jackson points out that CBD could affect certain cholesterol and blood pressure drugs, and a study published June 2017 in Cannabis and Cannabinoid Research detailed these interactions. Other side effects of CBD include tiredness, diarrhea, and changes in weight or appetite, the researchers write.
“What you put in your body is really important,” says Jackson, adding that’s especially true for people with major health conditions including diabetes. Jackson speaks from personal experience as a mom finding CBD treatments for her son’s epilepsy. She says consumers should ask manufacturers whether CBD products are free of mold, pesticides, and other toxins.
Realm of Caring, Jackson’s nonprofit, created a reference sheet for evaluating products and manufacturers. It also endorses products that adhere to standards such as those from the American Herbal Products Association and the FDA’s Current Good Manufacturing Practice regulations.
How to Talk to Your Healthcare Provider About Using CBD for Type 2 Diabetes
Jackson and Brady advise that people considering CBD for diabetes ask their providers about the complementary therapy before adding it to their treatment plan. Brady says it’s difficult to find research about CBD and type 2 diabetes, even in her capacity as a diabetes educator. Still, from her experience, if people are looking for a natural way to manage pain, it’s worth a conversation with their healthcare provider. “It’s something that should be talked about, especially if they’re having significant amounts of pain, or really any pain at all associated with their diabetes,” says Brady.
“It’s a reasonable alternative,” says Brady. “As it gains in popularity, there needs to be some information out there about it.