So, are you using a medication that can make it difficult to control your blood glucose levels? With which medications does this occur most frequently?
Courtesy — Freepik
A recently published review by Jain AB (University of British Columbia — Vancouver, Canada — Medscape, January 30, 2024) analyzes some of the medications, used to treat various diseases, that can potentially disrupt glycemic control.
This is very important when contacting the clinical or emergency doctor, who often does not know the patient’s history. Therefore, the doctor is unaware of the medications the patient uses regularly or any treatment recently started.
It is possible, then, that, in this primary or emergency care, the doctor identifies an increase in blood glucose levels, without being aware of all the medication that the patient is using.
This is of increased importance for the elderly. Some statistics indicate that around 50% of elderly people are diabetic. Some medications, such as corticosteroids, antipsychotics, diuretics (especially thiazides), statins (to correct high lipids), and beta-blockers, are widely used in clinical practice and are often prescribed for elderly people, due to the presence of high blood pressure, and increased cholesterol, changes in heart rhythm and other pathologies.
The use of some of these medications can lead to the onset of diabetes (for example, diabetes induced by corticosteroids) or can worsen or make blood glucose control difficult in patients with already diagnosed diabetes.
In some clinical situations, where medication for diseases other than diabetes is indicated, insulin administration and a review of the dietary plan may be necessary.
Once again, the doctor must be informed of all medications you use and your entire medical history.
Some of these medications can lead to obesity (a situation that can trigger the onset of diabetes) and/or lead to resistance to the action of insulin through a direct effect on pancreatic cells.
If you use diuretics from the thiazide family, such as hydrochlorothiazide or chlorthalidone, to control high blood pressure; this must be reported during medical care. From there, a serum potassium assessment will be requested. One of the factors that contribute to the elevation of blood glucose in thiazide users is the appearance of hypokalemia (low potassium in the blood). It is believed that the hypokalemia that occurs with the use of these medications leads to a decrease in insulin secretion and sensitivity. This appears to depend on the daily dose of thiazides used. This occurrence seems to be present in those who, more recently, started medication with thiazides, hence the importance of constant assessment of serum potassium for users of this medication, in particular, during the first year of prescription.
On the other hand, the medical prescription of beta blockers is quite common among cardiologists. These medications are used in cases of cardiac arrhythmia, coronary artery disease, and high blood pressure. The report of the beta blocker you are using is very important, as non-vasodilating beta-blockers, such as metoprolol and atenolol, more frequently cause an increase in blood glucose and body weight. These medications can also cause changes in blood lipids. Some of these beta blockers can cause hypoglycemia and can often mask some of the symptoms of hypoglycemia, often making diagnosis difficult.
Patients, especially the elderly, for whom these beta-blocker medications are prescribed, should be trained to recognize the signs of hypoglycemia in themselves, as well as know how to adopt corrective measures, in particular, those who are about to start therapy with beta-blockers.
Other medications are capable of altering glucose metabolism, such as antiretroviral therapy, immunosuppressants, alpha interferon, androgen deprivation therapy (goserelin and leuprolide, commonly used in the treatment of prostate cancer), and others.
Despite all this knowledge, medication-related hyperglycemia is very often underestimated. However, there is no doubt that establishing the cause-effect relationship is a challenge, especially when evaluating a patient who needs to receive many medications. In these cases, it is difficult to determine which one(s) is (or are) responsible for the hyperglycemia.
But there is good news!
Drug-induced diabetes is potentially reversible in most cases. However, it is worth highlighting that worsening glycemic control due to medication in people with pre-existing diabetes can also attenuate the effect of the prescribed medication itself.
Weight gain associated with corticosteroids and antipsychotics can make it difficult to know whether the development of diabetes was a primary or secondary effect of the medication. An interesting fact is that a medication can only cause hyperglycemia in some patients, suggesting that these patients may be more susceptible, or that other conditions make them more vulnerable. The risks for developing diabetes due to medication are the dose and duration of treatment and factors such as age, family history of diabetes, and body mass index.
Of course, the doctor faced with hyperglycemia will evaluate the role of the medications the patient takes. On the other hand, for a patient with low glucose tolerance, when starting a medication with a potential risk for hyperglycemia, frequent glycemic monitoring will be recommended. Therefore, in some cases, stopping or changing the medication may be considered. As we have seen, withdrawing the medication often resolves the situation.
This means that blood glucose levels must be monitored continuously to adjust diabetes medications whenever necessary. However, for some individuals, worsening glycemic status may be more chronic and require prolonged use of antihyperglycemic agents; In these cases, the doctor will only choose to continue the prescribed medication if its benefits exceed its potential risks.
When the diagnosis of diabetes already exists, the benefits and risks of administering hyperglycemia-inducing medications must be evaluated. If the use of the medicine is short, it is best to look for a medicine with little or no effect on blood glucose. If, on the contrary, the administration is necessarily prolonged, there must be adequate therapy, and, in some cases, it will be necessary to add insulin.
In some situations, such as, for example, men on antiandrogen therapy, they should be encouraged to participate in regular physical activity to reduce insulin resistance and, certainly, promote cardiovascular health.
But in fact, we all know the benefits of regular physical activity for our health in general.
References
. Simón A — CIM — 27 dezembro 2017
. Sena EP et al — Rev Bras Psiquiatr 2003;25(4):253–7
. Jain AB — Medscape January 30, 2024
. Moreira EB et al — Revista Multidisciplinar do Nordeste Mineiro, v7, 2023 ISSN 2178–69251
