Cannabis use in type 1 diabetes can mimic diabetic ketoacidosis but shows distinctly different lab values
Among 68 type 1 diabetes patients presenting with DKA-related codes, cannabis users had significantly higher pH (7.42 vs. 7.09) and bicarbonate (19.2 vs. 9.1), suggesting a distinct hyperglycemic ketosis from CHS rather than true DKA.
Quick Facts
What This Study Found
Cannabis users had dramatically different lab profiles than non-users: pH 7.42 vs. 7.09 and bicarbonate 19.2 vs. 9.1 mmol/L (both p<0.0001). The ROC curve for cannabis predicting hyperglycemic ketosis from CHS had an area of 0.9892, indicating near-perfect discrimination.
Key Numbers
Patients: 68. DKA events: 172. Cannabis users pH: 7.42 vs. 7.09 non-users. Bicarbonate: 19.2 vs. 9.1 mmol/L. ROC AUC: 0.9892. HK-CHS threshold: pH >=7.4, bicarbonate >=15.
How They Did This
Retrospective analysis of 68 adults with type 1 diabetes presenting with DKA-related ICD-10 codes (172 events). Cannabis use defined by positive urine test. Used linear mixed models and ROC analysis to distinguish hyperglycemic ketosis from CHS (pH >=7.4, bicarbonate >=15) from true DKA.
Why This Research Matters
Misdiagnosing CHS-related vomiting as DKA in type 1 diabetes leads to unnecessary aggressive treatment. This study provides clear lab criteria to differentiate the two conditions.
The Bigger Picture
As cannabis use increases among young adults with type 1 diabetes, clinicians need clear diagnostic tools to distinguish CHS-related ketosis from true metabolic decompensation.
What This Study Doesn't Tell Us
Small sample. Retrospective design. Cannabis use based on urine testing (indicates recent use, not necessarily current intoxication). Single-center study.
Questions This Raises
- ?How often is CHS misdiagnosed as DKA in type 1 diabetes?
- ?Could a pH threshold of 7.4 be incorporated into DKA protocols for cannabis screening?
Trust & Context
- Key Stat:
- ROC AUC of 0.99 for cannabis use predicting CHS-related ketosis vs. true DKA
- Evidence Grade:
- Small but well-analyzed cohort with near-perfect diagnostic discrimination.
- Study Age:
- Published in 2022.
- Original Title:
- Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.
- Published In:
- Diabetes care, 45(2), 481-483 (2022)
- Authors:
- Akturk, Halis Kaan(2), Snell-Bergeon, Janet(2), Kinney, Gregory L(5), Champakanath, Anagha, Monte, Andrew, Shah, Viral N
- Database ID:
- RTHC-03659
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Can cannabis use mimic diabetic ketoacidosis?
Yes. Cannabis users with type 1 diabetes can present with elevated blood sugar and ketones due to CHS vomiting, but their pH and bicarbonate levels are much closer to normal than in true DKA.
How can doctors tell the difference?
A pH of 7.4 or above with bicarbonate of 15 or higher in a cannabis-positive patient strongly suggests CHS-related ketosis rather than true DKA, with near-perfect diagnostic accuracy.
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Cite This Study
https://rethinkthc.com/research/RTHC-03659APA
Akturk, Halis Kaan; Snell-Bergeon, Janet; Kinney, Gregory L; Champakanath, Anagha; Monte, Andrew; Shah, Viral N. (2022). Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.. Diabetes care, 45(2), 481-483. https://doi.org/10.2337/dc21-1730
MLA
Akturk, Halis Kaan, et al. "Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.." Diabetes care, 2022. https://doi.org/10.2337/dc21-1730
RethinkTHC
RethinkTHC Research Database. "Differentiating Diabetic Ketoacidosis and Hyperglycemic Keto..." RTHC-03659. Retrieved from https://rethinkthc.com/research/akturk-2022-differentiating-diabetic-ketoacidosis-and
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.