Hidden Cannabis Use Caused Repeated Diabetic Emergencies in Type 1 Diabetes Patient

The patient experienced 6 DKA episodes in one year with persistent GI symptoms even after DKA resolved. Unusual lab findings (unexpectedly high pH and bicarbonate levels) eventually prompted screening for illicit drug use, revealing cannabis use and leading to a diagnosis of cannabinoid hyperemesis syndrome (CHS). The vomiting from CHS caused dehydration and poor insulin absorption, triggering repeated ketoacidosis.

Single case report documenting a type 1 diabetes patient with 6 DKA episodes over one year. Chart review of laboratory findings, clinical course, and eventual diagnosis.

Cannabinoid hyperemesis syndrome can masquerade as a diabetic emergency, leading to repeated hospitalizations and delayed diagnosis. In patients with type 1 diabetes, the vomiting from CHS creates a dangerous cycle of dehydration and ketoacidosis.

As cannabis use increases, clinicians need to consider CHS in diabetic patients with recurrent DKA, especially when presentations are atypical. Routine screening for cannabis use in patients with unexplained recurrent DKA could prevent repeated hospitalizations.

Single case report cannot establish frequency of CHS-triggered DKA. Patient may have had other contributing factors. The diagnosis of CHS itself relies on clinical criteria after excluding other causes. No follow-up data on outcomes after cannabis cessation.