We focus on a case concerning a 62-year-old Hispanic obese man (weight 113 kg, BMI 39 kg/m2) with a history of type 2 diabetes for 11 years began taking CBD Oil to control his blood glucose. This was in place of insulin degludec. The initiation of this product was independent of his clinician’s recommendation and based on the patient’s personal review of information suggesting CBD was beneficial for people with type 2 diabetes.
The week before the patient’s initiation of CBD, his A1C was 7.6%. He was taking his currently prescribed medications: insulin degludec 32 units subcutaneously daily, metformin 1,000 mg orally twice daily, and empagliflozin 25 mg orally once daily. The patient reported adherence to his medications 6 days out of the week.
Insulin degludec had been supplied as a sample, but his refill history suggested exceptional adherence to metformin and empagliflozin. His self-monitoring of blood glucose (SMBG) readings ranged from 124 to 176 mg/dL, with an average of 144 mg/dL.
Because he was not meeting his goal A1C of <7.0%, he was prescribed saxagliptin 5 mg to be taken once daily. The patient had no macrovascular complications of diabetes, and had normal liver and renal function, but did have albuminuria.
One week later, the patient contacted his provider to report that he had self-discontinued insulin degludec after an episode of hypoglycemia. He replaced his insulin therapy with 20 mg of oral CBD daily (SA Botanicals, San Antonio, TX).
Given his history of side effects to glucagon-like peptide 1 receptor agonists and refusal to use insulin again because of concerns about hypoglycaemia, the clinician agreed with his decision to discontinue insulin. They suggested evaluating the patient’s A1C on triple oral therapy plus CBD at his next visit.
At the next clinic visit, 6 weeks after his CBD initiation, the patient’s SMBG readings ranged from 122 to 158 mg/dL, with an average of 142 mg/dL.
Based on his refill history and self-report, he had been adherent to his regimen of metformin, empagliflozin, saxagliptin, and CBD oil. He reported no changes in diet or lifestyle, and his weight remained stable at 112 kg.
Because his SMBG readings had not drastically changed with the discontinuation of insulin degludec, no medication changes were made.
After 4 months of using CBD oil, the patient increased his CBD dose to 18 mg twice daily and self-reported benefits for joint pain management.
After 13 months of the patient’s same medication regimen, his A1C remained stable at 7.7%, and his weight was 113 kg.
Since the passage of the Farm Bill in 2018, which removed hemp and cannabis from the Controlled Substances Act provided they contain ≤0.3% THC, cannabidiol (CBD) has gained significant popularity.
The U.S. Food and Drug Administration (FDA) has sanctioned Epidiolex, a pharmaceutical-grade CBD, for the treatment of seizures associated with Lennox-Gastaut syndrome; however, the FDA has yet to endorse any other CBD products as safe and effective.
Nevertheless, numerous CBD products have been marketed for various medical applications.
The existing literature on CBD products as a medical treatment is still limited. A meta-analysis published in 2015 in the Journal of the American Medical Association reviewed 79 studies assessing CBD’s efficacy in treating various medical conditions. To date, the most promising evidence supports the use of CBD as a treatment for severe epilepsy, leading to the FDA’s approval of Epidiolex.
Due to a lack of comprehensive studies regarding the efficacy of CBD in the treatment of diabetes, its effects in this regard remain uncertain.
One study involving 62 patients with noninsulin-treated type 2 diabetes investigated the effects of CBD at a dosage of 100 mg twice daily, alongside tetrahydrocannabivarin (THCV) at 5 mg twice daily, for glycemic control. Findings from this study indicated a statistically significant reduction in resistin and an increase in glucose-dependent insulinotropic peptide, although changes were not significant compared to placebo.
Furthermore, surrogate outcomes suggested a potential improvement in glycemic control; however, noteworthy benefits on fasting plasma glucose levels and pancreatic β-cell function were solely associated with THCV, not CBD. These results from this limited study provide minimal confidence regarding the benefits of CBD for individuals with type 2 diabetes.
Several confounding factors may have influenced the efficacy outcomes in the presented case, but pertinent conclusions can be drawn regarding the safety of CBD in patients undergoing diabetes therapy.
The nearly simultaneous discontinuation of insulin degludec and the initiation of both CBD oil and saxagliptin raises questions regarding whether the CBD oil had a meaningful impact on blood glucose and A1C levels. Saxagliptin has been validated in significant clinical trials to effectively reduce A1C levels in patients already receiving metformin therapy. Given that the patient’s A1C and self-monitored blood glucose (SMBG) remained stable after replacing insulin degludec with CBD and initiating saxagliptin, it is plausible that saxagliptin masked any potential benefit from CBD.
However, dipeptidyl peptidase-4 inhibitors like saxagliptin typically reduce A1C by approximately 0.7–0.8%, which is unlikely to be equivalent to the A1C reduction achieved with the prior dosage of insulin degludec.
Additionally, the patient used a daily dose of 20 mg of CBD oil, which may not have been sufficient to elicit the benefits observed in previous trials. Finally, variability in the endocannabinoid system among individuals may impact the effectiveness of CBD for some patients.
The patient’s stable A1C and SMBG readings, along with his overall tolerance to this treatment regimen, suggests that the use of CBD was safe, despite the lack of definitive efficacy in this context. Furthermore, the relative stability of the patient’s A1C could be partially attributed to CBD. Typically, most patients would exhibit a significant increase in A1C after discontinuing a high-dose insulin degludec regimen.
However, the insulinotropic activity of CBD may have assisted in maintaining the patient’s glycemic control through a reduction in resistin levels. Elevated resistin has been associated with insulin resistance and obesity, making this a plausible mechanism for the patient’s stable A1C.
Beyond its potential role in improving glycemic control, CBD may offer macrovascular and microvascular benefits stemming from its anti-inflammatory properties.
No adverse effects were reported, including hypoglycemia or suspected CBD-induced hyperglycemia.
However, the FDA and a meta-analysis have indicated concerns regarding the potential for CBD products to cause liver injury, diarrhea, reduced appetite, male reproductive toxicity, irritability, agitation, and drowsiness.
The possibility of drug-drug interactions involving CBD also warrants consideration. CBD is known to be a strong inhibitor of cytochrome P450 and UGT enzymes, which means that medications metabolized by these enzymes may experience diminished efficacy and safety when used concurrently with CBD.
It is crucial to emphasize that the risk of adverse effects may be increased when using CBD products due to issues of misbranding and adulteration. Risks may also arise from patients opting for CBD over guideline-recommended therapies, as seen in this case. The widespread availability of CBD products, coupled with misleading marketing strategies, raises concern regarding unmoderated self-management of conditions that necessitate professional medical intervention.
This case does not substantiate the efficacy of CBD as an alternative treatment for uncontrolled type 2 diabetes. Nevertheless, it indicates that the use of CBD did not result in adverse effects or deterioration in diabetes management.
Health care providers should continue to support the use of established therapies and remain vigilant for potential negative outcomes associated with CBD, should patients opt for this treatment approach.
Providers must be prepared to engage in discussions about CBD, educating patients on the associated risks and the possibility of product adulteration and misbranding, thereby ensuring optimal patient care.
Reference:
Mattes RG, Espinosa ML, Oh SS, Anatrella EM, Urteaga EM. Cannabidiol (CBD) Use in Type 2 Diabetes: A Case Report. Diabetes Spectr. 2021 May;34(2):198-201. doi: 10.2337/ds20-0023. Epub 2021 Dec 23. PMID: 34149261; PMCID: PMC8178711.
Courtesy of the National Library of Medicine
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You may have come across discussions about using CBD for diabetes management. CBD, or cannabidiol, derived from the cannabis plant, does not produce a psychoactive effect. Research is ongoing to explore its potential in regulating blood sugar levels, reducing inflammation, and alleviating neuropathic pain associated with diabetes.
What the Research Indicates
Most studies on CBD and diabetes have been conducted in rodents, which can limit the applicability of findings to humans. Positive animal study results may not always apply to human subjects.
In one study, administering CBD to mice with reduced cerebral blood flow—associated with diabetes—showed that CBD:
– Decreased hyperglycemia
– Lowered cholesterol and triglyceride levels
– Enhanced insulin production
Other rodent studies suggested that CBD:
– Reduces inflammation and nerve damage-related pain
– May lower the risk of diabetes onset
– Converts white fat to beneficial brown fat, aiding glucose utilization.
THC and Diabetes
CBD and THC (the psychoactive cannabis compound) have different effects. One study indicated that while CBD did not improve blood sugar or lipid profiles in type 2 diabetes patients, a THC variant did show benefits. CBD lowered insulin resistance and raised gut hormone levels.
Use with Caution
CBD comes in various forms like tinctures and capsules, but most are not FDA-regulated. Epidiolex is the only FDA-approved CBD oil for epilepsy. Therefore, the authenticity and potency of other CBD products are uncertain, and some may contain THC.
Possible side effects of CBD include:
– Fatigue
– Drowsiness
– Diarrhea
– Dry mouth
CBD can interact with medications like anticoagulants, so it’s essential to consult a healthcare professional before starting CBD treatment.
Reference:
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