Breaking Down Hyperglycemic Ketosis-Cannabis Hyperemesis Syndrome in Type 1 Diabetes, with Halis Akturk, MD


At ADCES 2023, Halis Akturk, MD, presented data calling attention to the risk of hyperglycemic ketosis-cannabis hyperemesis syndrome in people with type 1 diabetes.

When Colorado became the first state to legalize recreational cannabis use in 2012, medical institutions and professional organizations within the state became the unofficial hubs for research related to the health impact of cannabis use.

Since retail sales began in 2014, the University of Colorado has emerged as a leader in this research, producing evidence of potentially harmful effects on both the pulmonary and cardiovascular systems.1,2 In the Barbara Davis Center for Diabetes at the University of Colorado, endocrinologists have also been sounding the alarm on a potential harm that has received less attention but poses a significant harm as it mimics diabetic ketoacidosis, in hyperglycemic ketosis-cannabis hyperemesis syndrome.

Diagnostic Criteria for HK-CHS

  • Venous Blood Glucose at 250 mg/dL or greater
  • Anion Gap greater than 10
  • Serum β-hydroxybutyrate greater than 0.6 mmol/L
  • pH at 7.4 or greater
  • Bicarbonate at 15 or greater

First described in a case series published in 2004, cannabis hyperemesis syndrome is characterized by recurrent episodes of nausea and vomiting with vague abdominal pain in the setting of chronic cannabis use.3 In 2021, Halis Akturk, MD, associate professor of Medicine and Pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado, and a team of colleagues published a study in Diabetes Care detailing notable differences in diabetic ketoacidosis and hyperglycemic ketosis due to cannabis hyperemesis syndrome among adults with type 1 diabetes based on a cohort of 68 patients hospitalized with 172 diabetic ketoacidosis events.4

Results of this study concluded cannabis users had significantly higher pH (7.42±0.01 vs 7.09±0.02) and bicarbonate (19.2±0.61 vs 9.1±0.71 mmol/L; P < .0001) compared with nonusers, with the area under the ROC curve for a positive cannabis urine test result predicting hyperglycemic ketosis-cannabis hyperemesis syndrome at 0.9892.4

At the Association of Diabetes Care and Education Specialists (ADCES) 2023 annual meeting, Akturk led a presentation on the effects of cannabis on the gastrointestinal system and the risk of diabetic ketoacidosis in type 1 diabetes. The session was aimed at detailing the differences between hyperglycemic ketosis due to cannabis hyperemesis syndrome relative to diabetic ketoacidosis as well as increasing education around the importance of discussions surrounding cannabis use in people with type 1 diabetes.

With an interest in learning more about the topic, HCPLive Endocrinology reached out to Akturk to learn more. That conversation is the subject of the video found below.

Relevant disclosures for Dr. Akturk include Medtronic and Tandem Diabetes Care.


  1. McGraw MD, Houser GH, Galambos C, Wartchow EP, Stillwell PC, Weinman JP. Marijuana medusa: The many pulmonary faces of marijuana inhalation in adolescent males. Pediatr Pulmonol. 2018;53(12):1619-1626. doi:10.1002/ppul.24171
  2. Campbell P. Robert Page, pharmd: Marijuana and cardiovascular health. HCP Live. August 13, 2020. Accessed August 8, 2023.
  3. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53(11):1566-1570. doi:10.1136/gut.2003.036350
  4. Akturk HK, Snell-Bergeon J, Kinney GL, Champakanath A, Monte A, Shah VN. Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes. Diabetes Care. 2022;45(2):481-483. doi:10.2337/dc21-1730
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