Medications That Raise Blood Glucose
Battling high blood glucose? Your meds may be to blame. Here’s what you need to know
When your blood glucose is trending high, you may run through a list of questions: What have I been eating over the past few weeks? Is something causing me stress? Am I fighting off a cold? All good questions, but you may also want to turn your attention toward your medicine cabinet: Certain prescription and over-the-counter drugs are known to cause upticks in glucose levels.
Spotlight on Steroids
In terms of prescription medications, some are strongly associated with elevated blood glucose while others have a weaker association, says Oluwaranti Akiyode, PharmD, BCPS, CDE, an associate professor at Howard University College of Pharmacy. The number one offender: corticosteroids, often simply referred to as “steroids,” which include drugs such as prednisone and dexamethasone.
Steroids are used to treat a host of health problems. The dose, duration, and how the steroids enter your system are all important in determining how your blood glucose is affected and how closely your diabetes medications need to be monitored, says Izabela Collier, BS Pharm, PharmD, CDE, clinical assistant professor of pharmacy practice at Western New England University. Oral steroid medications and injections into joints or body tissues will almost always increase blood glucose, she says, because this type of administration affects the whole body—what doctors refer to as systemic absorption. “We have to combat it either by increasing what [diabetes medications] they are on or adding other agents.”
If you need to use a steroid inhaler for asthma or hydrocortisone cream for a rash, the risk of increased blood glucose is minimal. “[Hydrocortisone creams] don’t have systemic absorption, and what is absorbed would be insignificant,” Collier says. “And if you use a steroid-based inhaler, that drug is specifically designed just to work on certain organs, such as the lungs, so you don’t see the glucose spikes in those patient populations.”
Nonetheless, while the risk may be low for these types of steroids, blood glucose “needs to be monitored closely, irrespective of if it’s inhaled, oral, topical, or injected,” says Akiyode. When you receive a steroid prescription, be sure to ask your doctor whether you should check your blood glucose more often.
The risk of high blood glucose also depends on the dose of the steroid: “In a large dose of inhaled or topical, there may be some effect,” says Alan Garber, MD, PhD, professor of medicine in the Division of Diabetes, Endocrinology, and Metabolism at Baylor College of Medicine.
This is especially true for people taking oral or injected steroids—the larger the dose and the longer you take it, the higher the risk of hyperglycemia, says Akiyode. Not only that, but the increase in blood glucose will be greater than if you took a smaller dose for a shorter amount of time.
If you’ll be taking steroids for a longer period of time, Collier says there needs to be a plan in place to adjust your diabetes medications. For example, a course of oral prednisone may start at 40 to 60 milligrams and then taper over several weeks. With this dose, you may need more diabetes medication, though that will decrease as you gradually reduce your steroid dose. Steroid treatment and tapering may also involve taking the steroid every other day instead of daily. “Many times, for a patient on insulin, I will alter the doses of insulin on steroid days versus non-steroid days,” Collier says.
People treated with steroids for a shorter period of time—less than a week or so—or those who rapidly taper off the drugs may not need to make any adjustments to their diabetes regimen.
A Wrench in the Wheel
While scientists aren’t exactly sure why steroids raise blood glucose, there are a few theories. “Most [steroids] tend to affect how insulin works in the body,” Akiyode says. “It is also decreasing insulin sensitivity and increasing the production of glucose in the liver.”
Studies also are trying to clarify whether steroids can trigger type 2 diabetes. The question: Do they cause new diabetes or do they unmask underlying, pre-existing diabetes? “Some of the studies are showing that it seems like steroids are actually causing some new onset,” Akiyode says.
If you have to be on long-term steroids for your health, control what you can—maintain a healthy lifestyle and take medications as directed—to help keep blood glucose on target. “Try to make sure you’re exercising. And lose weight, if necessary, to try to help minimize the risk factors,” Akiyode says.
Beta blockers and thiazide diuretics, which are used for the treatment of high blood pressure, have been linked to elevated blood glucose, though the connection is not as strong as it is with steroids. Statins, used to lower cholesterol, also are associated with raised blood glucose.
Much of the diabetes population will need to take one or several of these drugs. The dose and how long you take these medications may also be a factor. A higher dose of thiazide diuretics is associated with higher blood glucose levels, but the elevation may not take effect for weeks or months, says Akiyode.
Long-term use of beta-blockers may also bring higher risk of elevated blood glucose, but the increase usually happens during the first few weeks of taking the medication. Similar observations have been made about statins. A higher dose of statins is also more strongly associated with elevated blood glucose than a more moderate dose.
It doesn’t mean you should not use these medications, Akiyode says. But you should be monitored closely. “The provider can make appropriate adjustments, if necessary, to the diabetes medication.”
The important message, she says, is that benefits outweigh the risks. “[For people who need them,] statins, beta blockers, and diuretics are really good drugs for people with diabetes to use.”
Less Common Meds
While you may need to take steroids, statins, and blood pressure medications at some point in your life, there are several drugs used less frequently that can elevate blood glucose. These include drugs to treat people with schizophrenia, HIV, and organ transplants, says Oluwaranti Akiyode, PharmD, BCPS, CDE, an associate professor at Howard University College of Pharmacy.
- Antipsychotics—Clozapine and olanzapine have the strongest association with elevated blood glucose, though not all antipsychotic drugs do so.
- Protease Inhibitors—These antiviral drugs, used for the treatment of HIV and hepatitis C, have been shown to increase blood glucose.
- Tacrolimus—This immunosuppressive drug is typically used after an organ transplant and has the added risk of elevating blood glucose.
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