CBD and Metformin

Can CBD oil help with diabetes, and will it interact with metformin?

Diabetes management requires careful and consistent control of blood sugar levels.

Diabetes patients are at significant risk of severe health complications, such as stroke, kidney failure, heart disease, vision loss, amputation of legs, feet, or toes, and early death.

Diet and lifestyle changes, as well as the use of insulin and oral medications, such as metformin, help lower blood sugar levels. 

Unfortunately, some diabetes medications can cause undesirable side effects, such as dizziness, nausea, and stomach cramps.

Emerging studies and research indicate that cannabidiol (CBD) oil may be beneficial as a useful supplementary therapy for diabetes.

CBD’s anti-inflammatory properties may help in managing a diabetes patient’s condition by reducing inflammation. CBD may also reverse the harmful effects of high glucose, as a study demonstrates.

Metformin is a conventional diabetes medication that helps patients control their blood sugar levels. 

However, experts advise patients who take metformin and CBD to be cautious and check their blood sugar levels as cannabinoids counter the drug’s effect of lowering blood sugar.

Still, for those looking to use CBD as a supplement to their diabetes therapy, this article lists down some products recommended for managing diabetes symptoms.

What the Statistics Say

According to the Centers for Disease Control and Prevention (CDC), as many as 40% of Americans would develop type 2 diabetes throughout their lifetime.

The National Diabetes Statistics Report, 2017 examined the health data through 2015, and the key findings were: 

  • 1 in 10, or 30.3 million Americans, have diabetes.
  • Of the newly diagnosed diabetes cases, more than 50% were in patients 45 to 64 years old.
  • There has been an upsurge of newly diagnosed cases of type 1 and type 2 diabetes among US youth.
  • About 90% of adults diagnosed with diabetes were overweight. More than 40% were physically inactive, and 16% were smokers.

Understanding Diabetes

Diabetes is a result of the body’s inability to utilize the carbohydrates (starches and sugars) it takes in as food to produce energy. The body either cannot produce any insulin or too little of it.

Diabetes occurs when blood sugar, or blood glucose, rises to high levels. 

The three common types of diabetes are:

1. Type 1 Diabetes

This is an insulin-dependent diabetes. Because it usually starts during childhood, type 1 diabetes also used to be called juvenile-onset diabetes.

People with type 1 diabetes have damaged pancreas that cannot produce insulin.

Treatment for type 1 diabetes requires significant lifestyle changes that include frequent testing of the patient’s blood glucose levels, healthy eating, daily physical exercise, and taking insulin and other medications.

2. Type 2 Diabetes

This is also referred to as non-insulin-dependent diabetes or adult-onset diabetes. However, nowadays, more teenagers are now developing type 2 diabetes. With Type 2 diabetes, the pancreas produces insulin in the amount that either is not sufficient for the body’s requirements, or the body’s cells are resistant to it.

The lack of sensitivity to insulin (insulin resistance) mostly occurs in muscle, liver, and fat cells.

Most people with type 2 diabetes have to take pills, insulin, or both to help them manage their condition.

For both types of diabetes, the symptoms are similar, and they include feeling very thirsty and drinking a lot, frequent urination, feeling very hungry and fatigued, having blurry vision, and wounds that do not heal properly.

3. Gestational Diabetes

Gestational diabetes is usually first observed in a pregnant woman who has never had diabetes before becoming pregnant. 

Often, gestational diabetes can be controlled by eating a healthy diet and keeping physically active. In some cases, a woman with gestational diabetes must take insulin.

The Centers for Disease Control and Prevention (CDC) advises women who have had gestational diabetes to continue to eat a healthy diet and to exercise after pregnancy to avoid or delay getting type 2 diabetes. 

Problems of Diabetes in Pregnancy

Blood sugar that is not well-managed when pregnant and diabetic could lead to problems for both the mother and the baby, such as:

  • low blood sugar (hypoglycemia) in the mother
  • miscarriage or stillbirth
  • preterm birth can result in problems for the baby, such as breathing difficulty, heart ailment, bleeding into the brain, intestinal disorders, and vision problems
  • congenital disabilities in the developing baby, such as those of the brain, spine, and heart
  •  high blood pressure (preeclampsia) in the mother which could lead to seizures or a stroke during labor and delivery

Treatment Options for Diabetic Patients

There are different classes or types of drugs that work in different ways to lower blood sugar levels in patients with diabetes.

The American Diabetes Association (ADA) lists the following treatment options:

  • Alpha-glucosidase inhibitors
  • Biguanides (Metformin)
  • Bile Acid Sequestrants
  • Dopamine-2 Agonists
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors
  • Meglitinides (glinides)
  • Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors
  • Sulfonylureas
  • Thiazolidinediones—sometimes shortened to TZDs or glitazones 
  • Oral combination therapy

Metformin

Biguanides boost the activity of insulin by lowering glucose levels that the liver releases into the bloodstream. Biguanides also increase the absorption of blood glucose into the cells.

Metformin, commonly used as a first-line treatment for type 2 diabetes, is the only licensed biguanide in the United States. It is usually administered as a monotherapy (single treatment), but it can also be combined with other medications in a single tablet. 

Metformin is also sometimes prescribed in combination with insulin for people with type 1 diabetes. The drug improves insulin sensitivity and decreases insulin resistance, as one research shows. 

Usually taken twice a day, metformin helps to lower blood sugar levels by making muscle tissues more sensitive to insulin so that glucose can be absorbed.

Typical side effects of diabetes drugs like metformin include bloating, diarrhea, gas, nausea, and stomach upset, which can all be alleviated when the drug is taken with food. Also, once the body gets accustomed to the medicine, the problems disappear. 

CBD for Diabetes: What the Research Says

CBD products proliferate the market nowadays. They may come in the form of lip balms, tincture oils, salves, body lotions, and skin creams. They are also found in CBD-infused edibles and beverages like brownies, gummies, sodas, and coffees.

Experts are not sure how CBD can help remedy or reverse insulin resistance, or how CBD oil and diabetes are correlated. However, most of them are confident that CBD’s anti-inflammatory properties are beneficial in managing a diabetes patient’s condition.

Results of a study suggest that the stimulus of cannabinoid receptors CB-1 in the islet (cluster) cells may be linked to insulin production.

Insulin resistance is linked with chronic inflammation, as this study indicates.

Meanwhile, in another study, CBD was shown to reduce the incidence of diabetes in non-obese diabetic animal models. 

Another risk factor for diabetes is obesity, and research has shown that CBD has been associated with low levels of fasting insulin and reduced waist circumference.

Overall, initial studies on CBD for diabetes have been promising that Dr. Joseph Alpert of the American Journal of Medicine called on the National Institute of Health (NIH) and the Drug Enforcement Administration (DEA) for more funding and collaboration on further research.

CBD for Diabetes: What the Experts Say

Currently, there are more than 75 human clinical studies and case reports on cannabis and cannabidiol for conditions ranging from anxiety to blood pressure, seizures, post-traumatic stress disorder (PTSD), neuropathic pain, Parkinson’s disease, bipolar depression, and cocaine dependence. 

However, not one study focuses on diabetes. 

Only one study directly examined the effects of cannabidiol on blood sugar and insulin levels in diabetic patients. 

In that study, researchers concluded that CBD and THCV (tetrahydrocannabivarin), another cannabis compound, showed no detectable metabolic effects on blood sugar, insulin sensitivity, and cholesterol in people with type 2 diabetes.

Taz Bhatia, M.D., an integrative medicine doctor, said: “I do not know that I would recommend CBD oil for diabetes. I think it is ok to try it, but do not skip or cut back on diabetes medications.”

Eileen Konieczny, RN, former president of the American Cannabis Nurses Association and author of the book, Healing with CBD: How Cannabidiol Can Transform Your Health Without the High, agrees.

Konieczny said: “I have not witnessed blood sugar control or management with CBD alone. CBD clearly will help with the inflammation that accompanies diabetes and, in that way, can be a beneficial addition.”

How CBD Interacts with Metformin and Other Drugs

When combined with cannabis, the impact of prescription drugs can either be amplified or weakened.

CBD can interact with other pharmaceuticals that, like itself, are broken down in the body by cytochrome P450 enzymes. 

As CBD competes for these enzymes, CBD reduces the metabolism of the drugs, increasing the drugs’ concentration levels in the bloodstream.

There is high-quality evidence from preclinical studies that the endocannabinoid system also influences diabetes‐induced oxidative stress and inflammation. Results suggest that the ECS mitigates insulin sensitivity rather than strictly inhibiting it.

NSAIDs (non-steroidal anti-inflammatory drugs) are sometimes used to treat chronic low-grade inflammation in patients with diabetes. Several patients report that using cannabis with NSAIDs relieves them of painful symptoms. 

However, cannabis has been shown to decrease the effectiveness of metformin, as cannabinoids counter the drug’s effect of lowering blood sugar, as explained by Community Base Dispensary on their website.

Experts advise patients who take metformin and CBD to be cautious and check their blood sugar levels. 

 To date, there have been no noteworthy studies confirming that CBD oil can reduce blood sugar levels. Together with exercise and a healthy diet, diabetes medications, such as metformin, should be the primary focus of diabetes treatment and management.

Best CBD Products for Diabetes

For people who dislike the idea of having to take drugs for quite a long time to manage a chronic disorder, CBD oil is a natural alternative.

Below is a list of CBD products for those who are looking to supplement their diabetes therapy with CBD oil.

  1. CBDPure CBD Oil is made with non-GMO hemp, grown in Colorado by local farmers. The company’s hemp oil is third-party lab-tested for potency and quality. Their stringent testing program ensures that consumers get the best and most potent CBD oil available.
  2. Sabaidee CBD Oil is derived from cloned seeds, making the quality consistent no matter what the season is. Each oil product has 3 main components: full-spectrum hemp extract, MCT oil from coconut, and peppermint oil.
  3. Fab CBD products are extracted from hemp plants grown with zero pesticides in a 100% organic environment. The oil comes in three flavors for people who cannot stand the natural taste of CBD oil. Each flavor is made from full-spectrum CBD and has 0.3% THC (tetrahydrocannabinol).

Conclusion

There have been no longitudinal clinical trials on humans on the effects of CBD on diabetes. 

Also, the limited amount of research available has been carried out on animal models in a laboratory.  This type of setting is far from the ideal rigorous clinical conditions that yield high-quality evidence that doctors require to establish a substance as an available medication.

Experts advise diabetic patients, who are looking to improve their health conditions with CBD oil, to first consult with a medical professional experienced in cannabis medicine.

However, take note that the U.S. Food and Drug Administration (FDA) strongly advises “against the use of CBD, THC, and marijuana in any form during pregnancy or while breastfeeding.”

Susan Lindeman

Susan is a young mother and writer, passionate about cooking and blogging. She makes CBD-infused foods, like cookies and candies, to help her cope with anxiety and perform her daily tasks better.
Susan Lindeman

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Metformin Use During the First Trimester of Pregnancy – Is it safe?

QUESTION

A pregnant patient with polycystic ovary syndrome asked me whether continuing metformin, which she was taking to treat infertility before her pregnancy, was safe for her fetus. She had heard that metformin is a “drug for diabetes.” How safe is metformin use during the first trimester of pregnancy and beyond?

ANSWER

Despite the traditional response that all oral hypoglycemic agents are absolutely contraindicated during pregnancy, evidence that metformin is probably safe during the first trimester of pregnancy and beyond is accumulating.

Metformin is currently approved by the United States Food and Drug Administration for treatment of type 2 diabetes. The most current product monograph still lists pregnancy as a contraindication to metformin; however, in both Canada and the United States, its off-label use in treatment of infertility caused by PCOS is growing.

Metformin is known to facilitate conception in women who have oligomenorrhoea and PCOS. Recent studies have suggested that metformin use during pregnancy decreases the high incidence of spontaneous abortion associated with PCOS (30% to 50%)9 and with gestational diabetes (31% in untreated women vs 3% in treated women).

Whether metformin causes teratogenicity in animals is controversial. Some animal studies found no evidence of teratogenicity at doses as high as 600 mg/kg daily. One study showed that metformin at doses similar to clinical in vivo levels had no direct toxic effects on mouse embryo development. 

Another study showed that, although exposure to both biguanides, phenformin and metformin, were associated with embryo death, phenformin has greater toxicity in mouse whole embryo culture, suggesting that metformin might be safer to use during pregnancy. 

Other studies, however, have suggested that metformin induces a low incidence of malformations in rats. For women taking metformin for PCOS, the question of teratogenicity remains challenging because it is difficult to clarify whether the teratogenic potential is subsequent to poor glycemic control or subsequent to the direct actions of the oral hypoglycemic drug itself.

Results of Metformin Use During the First Trimester of Pregnancy

No evidence shows that metformin use during the first trimester of pregnancy in women with PCOS is associated with increased risk of malformations.

Most of the studies applicable to PCOS restricted exposure to the first trimester, i.e., metformin was discontinued as soon as pregnancy was diagnosed. Evidence beyond the first trimester is anecdotal at this point.

Large well-controlled studies of humans are needed. For women with non-insulin-dependent diabetes mellitus, insulin is still considered the treatment of choice during pregnancy, although glyburide has been shown not to cross the human placenta.

Use of Hypoglycemic Drugs During Lactation

QUESTION

My patient was taking glipizide (an oral sulfonylurea) for type 2 diabetes. Now she is pregnant and taking insulin instead. She is very anxious to return to her previous treatment immediately after delivery because of the pain and hurdles associated with the administration of insulin. 

Can sulfonylureas cross into human milk and, if so, is it safe for her to breastfeed her infant?

ANSWER

The exposure of infants to second-generation sulfonylureas (eg, glipizide, glyburide) through breast milk is expected to be minimal, based on the limited data available. 

Women with type 2 diabetes treated with sulfonylureas should not be discouraged from breastfeeding. The benefits of breastfeeding greatly outweigh the risks of these medications, if any. The baby should, however, be monitored for signs of hypoglycemia.

Effects of the Use of Hypoglycemic Drugs During Lactation

First-generation sulfonylureas have, to a limited extent, been shown to cross into breast milk. Tolbutamide is excreted into breast milk in small amounts (less than 0.5% of the maternal weight-adjusted dose). 

A 500-mg dose of tolbutamide twice daily produced milk levels of 3 and 18 µg/mL in 2 patients, with milk-to-plasma ratios of 0.09 and 0.40, respectively.8 In 1 patient, chlorpropamide was found in breast milk at concentrations of 5 µg/mL (approximately 10% of the maternal weight-adjusted dose) after a 500-mg maternal oral dose.

No clinical effects to the exposed infants were reported. Transfer of second-generation sulfonylureas into breast milk has been studied, with similar results.

Metformin and the Use of Hypoglycemic Drugs During Lactation

Metformin is a widely used oral, biguanide hypoglycemic drug for the management of type 2 diabetes. Metformin stimulates glucose uptake in the liver and peripheral tissues and decreases hepatic glucose production. These actions are the result of an enhanced tissue response to insulin and therefore require the presence of insulin. Metformin is not expected to cause hypoglycemia.

Final Thoughts on the Use of Hypoglycemic Drugs During Lactation

The available data suggest that the levels of glyburide and glipizide in milk are negligible and would not be expected to cause adverse effects in breastfed infants; however, as data are based on a single study with a limited sample size, monitoring of the breastfed infant for signs of hypoglycemia is advisable during maternal therapy with any of these agents.

Treatment with metformin during lactation is unlikely to lead to toxicity in the breastfed infant. Given the safety profile of metformin, as compared with sulfonylureas, it is advisable to consider metformin as first-line treatment during lactation if this drug is appropriate for the particular patient. Nevertheless, second-generation sulfonylureas are also likely to be safe during lactation.

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