Diabetes, Cannabis and Anxiety
The following excerpts were written to clarify the situation regarding cannabis use, diabetes, and the causes of anxiety that some users may experience:
"...The causes of cannabis anxiety and paranoia are both mental and chemical. Although some episodes of anxiety can be created by your expectations and fears about having a bad high, or just simply taking cannabis, it's more likely that much of your discomfort is being created by the things I talk about below. Even if you've never had a moment's anxiety with cannabis in your life, it'll be useful if you can read through the following just in case it should ever happen – and just to check that you really are avoiding these pitfalls.
Changes in blood sugar levels can be responsible for pretty extreme effects (both good and bad) when you're high, so you have to pay real attention to it if you want to get, and keep, a good high. Too much blood sugar, from eating a lot of candy for example, and you get a rush as the cannabis high and the sugar high combine – but the sugar high is short-lived, and will make you want to fall asleep as soon as your system burns off the excess insulin that all the sugar has forced the release of. Too little blood sugar, and things go from uncomfortable to extremely unpleasant very quickly. As you first start to get high, your metabolism may hike up a notch and cause a sudden dip in blood sugar. That's no problem if you've just eaten, but if you're already on the edge of being hungry without realising it, that first toke can make you feel pretty nasty in less than ten minutes. Never take the chance of getting high when you're somewhere without access to the right kinds of food and drink, just in case. If you have the added 'pleasure' of being a borderline diabetic and you don't know it, you could get into quite a state from just that one first high, if you're not careful.
In terms of the things that make you feel mentally and physically good or bad, blood sugar is way up there with the best of them. As the effects of even slightly low blood sugar can be so extreme as to literally stop us thinking clearly and sanely, it has to be something to consider all the time you're high.
4.20, And Why It May Be Bad For Us
There are good reasons why the traditional idea of starting toking at 4.20pm may not be the good idea we all tend to think it is. Many regular cannabis users begin their day's session in the late afternoon as work is winding down, and maybe an hour or two before their evening meal – just at the very time when their blood sugar is already on the wane. If this is you, you'll more than likely feel a lot of the symptoms below within ten minutes or so of getting high. Eat! Better still, make sure that you've eaten well in advance of getting high.
For any cannabis user, even without food binges, the increase in metabolism that cannabis can create burns off blood sugar very quickly, so you're much more likely to have the symptoms listed below. Look out for any of the following as indicators of low blood sugar:
Sweating, shaking, anxiety, hunger, dizziness, faintness, pounding heart, personality changes, confused thinking, impatience, numbness of lips and tongue, headache, nausea, blurred vision, slurred or slow speech, convulsions, coldness, white hands and face. Eventually, if it is not attended to, it can lead to unconsciousness.
Adrenaline & Cannabis
A second cause of dope-anxiety is something I term here the 'Adrenaline Cascade'; really a mild form of 'shock'. After any event that has made you anxious, the anxiety causes your system to dump adrenaline (also called epinephrine) into your blood-stream, creating a rapid heart-beat, a growing demand on your BSL, and thus deeper and deeper feelings of anxiety as your BSL levels drop. Of course, you'll usually find these effects uncomfortable or worrying, thus causing the release of even more adrenaline and a worsening of symptoms. This vicious circle of adrenaline release will be increasingly hard to overcome, and the deeper it gets the more likely it is to lead to a 'white-out' due to its depressive effects on your blood sugar.
Many things trigger the release of adrenaline:
Apprehension about potentially bad highs
Stimulants, such as alcohol, caffeine, cocaine, and heroin.
Abnormal glucose metabolism
Again, do not underestimate the mental effects that adrenaline can cause by itself - irregular heart-beat, palpitations, abnormal behaviour, anxiety and headaches - even before it starts reducing our BSL to a point where it can no longer support full brain function (about 60% of our blood sugar is used by our brains).
Unfortunately, there's very little you can do to remove excess adrenaline from your system once it's in there, and it can only really be counteracted by 'nor-adrenaline', something that usually only our bodies can provide. It can be burned off by exercise, but if adrenaline has caused a very deep dip in your BSL then that may not be a viable option. The only things you can truly do are: eat to get rid of some of the more unpleasant symptoms; or, simply wait it out, knowing that it is a brief physiological effect.
I've seen a number of people offering advice to 'just suck it up and it'll go away' on this particular kind of anxiety and, to some extent that is helpful, as relaxing and trying to be calm will help break the cycle of adrenaline release. On the other hand, if someone is having an intense version of this then relaxing is far easier said than done and, if you should experience the above yourself, then you need to treat yourself as you would for low BSL and the effects of a grade 4 high (see later), removing yourself from any strong stimuli - lights, noises, etc. - that might help promote the effects of the high and further adrenaline release.
It's interesting to consider all of the effects that adrenaline has on our systems, especially when we're high, especially in light of the small amount of research that's been done into cannabis and the control of BSL in diabetics. Cannabis works for some diabetics in this respect, but not all. Some have found that it lowers BSL and helps control the illness, others that it has no effect at all, which may simply be down to the amount of adrenaline they might or might not produce when they're high. Many have rigorously self-tested their BSL and found that cannabis causes an initial rise in blood sugar (caused by increased hydrolysis of glycogen to glucose), followed by a low period where they're unable to return their background sugar levels to a normal level.
If we look at the actions of adrenaline in this respect then the mechanism that prevents this rise becomes obvious (remember that this same effect will be present in anyone who has a burst of adrenaline in their systems, not just diabetics): adrenaline prepares the body for 'fight or flight' in an emergency by increasing the supply of glucose and oxygen to the brain and muscles, whilst at the same time suppressing other less-important processes, digestion in particular. This means that the initial elevation in blood-sugar (through increased catabolism) may be short-lived, and whether it then leads to a later dip and anxiety is dependent on the amount of adrenaline present in the blood at the time. Not only does it reduce the bodies ability to take in new blood sugar to redress the balance, but it increases speedier depletion of stored blood sugar, preventing restoration.
Some people, particularly those with bad diets or who are subjected regularly to stress, may have semi-permanent hypoglycemia (a deficiency of glucose in the blood), resulting in adverse reactions to cannabis through their bodies inability to control adrenaline and/or cortisol through 'adrenal fatigue'.
In light of the above, those who know they're already at risk from fluctuating BSL will find that their symptoms of anxiety during cannabis use will be significantly reduced if they can pay full attention not only to those levels before use, but also setting and mood before use, as recommended in other chapters here.
Testing for Hypoglycemia
'Many more people believe they have hypoglycemia than actually test positive when given blood-sugar tests...
Dr. Callaway suspects that people can experience pharmacological effects from sugar, even if blood-sugar levels remain within the normal range. People's responses to fluctuating blood-sugar levels vary greatly. Some people experience symptoms when blood-sugar levels are well within the normal range, while others report no symptoms even when blood-sugar levels have dropped substantially. It is likely that each person has a unique blood-sugar range, with fatigue or mood changes occurring when levels fluctuate above or below these levels. (Pages 109, 112)'
'Food & Mood' Somer, Elizabeth, M.A., R.D. (Henry Holt and Company, LLC, 1999.)
Excerpted from 'Cannabis & Meditation – An Explorer's Guide', by Simon Jackson. Headstuff Books 2007. www.headstuffbooks.com