Cannabis and its organic compounds
The term cannabis is used to refer to a known plant, as well as preparations derived from it that are consumed in various ways, especially smoked, and that have narcotic or therapeutic properties. This plant, whose scientific name is Cannabis sativa, produces in its trichomes a variety of defensive organic compounds known as cannabinoids. These cannabinoids differ from other molecules produced by animals (endocannabinoids) or synthesized in the laboratory (synthetic cannabinoids), and are specifically called phytocannabinoids. Although the plant produces numerous phytocannabinoids, only a few of them have been studied. The most notable are tetrahydrocannabinol (THC) and cannabidiol (CBD), which are the most abundant in the plant. THC is responsible for the psychotropic effects of cannabis, as well as stimulating appetite and having analgesic and anti-inflammatory properties. On the other hand, CBD also has anti-inflammatory and antioxidant properties, and unlike THC, it does not have psychotropic properties.
The endocannabinoid system: an internal signaling network
Research into the mechanisms by which cannabis exerts its psychotropic effects in humans led to the discovery of cannabinoid receptors in the 1990s. These receptors, called CB1 and CB2, are part of a family of transmembrane receptors known as GPCRs. They are found in the membranes of many cells in our body, both in the plasma membranes and in the mitochondria. Although the THC in cannabis has the ability to activate these receptors and trigger a molecular response similar to that of natural endocannabinoids, CB1 and CB2 are not part of a natural response system to phytocannabinoids, but rather are part of a signaling system internal between cells that has multiple functions. This system is known as the endocannabinoid system and is composed, in addition to the CB1 and CB2 receptors, of endocannabinoids, which are the endogenous substances that naturally activate the CB1 and CB2 receptors, and of the enzymes involved in the synthesis and degradation of endocannabinoids. The function of the endocannabinoid system in our body is homeostatic or modulatory, that is, it regulates the magnitude of other signaling processes between cells to avoid harmful effects, ensure adequate negative feedback and guarantee effective communication between cells.
The endocannabinoid system and glycemic control
In addition to its role in modulating cell signaling, the endocannabinoid system also controls glucose metabolism. It does this by inducing pancreatic insulin secretion, decreasing hepatic insulin clearance, and increasing insulin-induced lipogenesis in the liver and skeletal muscle. This means that the endocannabinoid system plays an important role in controlling blood glucose levels. However, excessive activation of this system, for example through cannabis use, can interfere with normal glycemic control and have negative consequences in people with diabetes. Scientific studies have shown that cannabis use is associated with an increased risk of diabetic ketoacidosis in people with type 1 diabetes, as well as an increased risk of complications in people with type 2 diabetes, such as cardiovascular disease and kidney disease. Additionally, chronic cannabis use can cause insulin resistance and increased visceral adiposity, which worsens glycemic control and makes diabetes management more difficult. Therefore, in people with diabetes, the regular use of cannabinoids is not recommended.
The therapeutic use of cannabinoids in the treatment of diabetes
Although cannabis use as such can be harmful for people with diabetes, certain compounds derived from cannabis, such as THC and CBD, have been shown to have therapeutic properties. Importantly, cannabis use itself does not induce diabetes, but may worsen glycemic control and diabetes-related complications in people who already have the disease. However, there are cannabinoid-based drugs that are being investigated in clinical trials and that could have potential for the treatment of diabetes. For example, peripheral CB1 receptor blockers have been shown to be effective in reducing weight and improving the metabolic profile in people with obesity and diabetes. Although these drugs are not yet commercially available, it is expected that in the future they will be part of the therapeutic arsenal against diabetes. In addition, CBD, due to its anti-inflammatory and antioxidant properties, could also have therapeutic potential in the management of diabetes. However, more clinical studies are needed to evaluate its effectiveness more precisely and determine if it can be useful in the treatment of this disease.
