Medications that can increase glucose levels

Different medications can have side effects beyond the disease state they’re used to address, and among the most common complications of many medications is the potential to disrupt glycemic control.

Here are some of the most commonly used medications that are known to increase glucose levels, as well as some practical tips on overcoming these.

1. Glucocorticoids

Corticosteroids are at the top of the list when it comes to the potential for increasing blood glucose levels. High-dose glucocorticoid therapy is known to lead to new-onset diabetes, and people already with diabetes may notice significant worsening of glycemic control when they start on glucocorticoid therapy.

Those with previously well-controlled diabetes or borderline diabetes, glucocorticoid-induced hyperglycemia may be managed by metformin, especially if corticosteroid treatment is low-dose and for a shorter duration. However, for many individuals with preexisting poorly controlled diabetes or those initiated on high-dose corticosteroids, insulin therapy would perhaps be the treatment of choice.

2. Antipsychotic Therapy

Between 15% and 72% of people who take second-generation antipsychotics experience weight gain of 7% or more – a factor contributing to an elevated risk of developing Type 2 diabetes. Antipsychotics are also thought to cause downregulation of intracellular insulin signaling, leading to insulin resistance.

Given these risks, the safest approach involves starting with medications that have a lower propensity for weight gain, and the partial agonists/third-generation antipsychotics presently have the best overall data.

3. Thiazide Diuretics

Thiazide diuretics are commonly used for the management of hypertension and are associated with metabolic complications including elevated glucose. It’s thought that the reduced potassium level occurring as a result of these medications might contribute to new-onset diabetes.

It’s important to monitor potassium levels for those initiated on thiazide diuretic and to use potassium supplements to mitigate the risk for new-onset diabetes.

4. Statin Therapy

Statin therapy is thought to be associated with decreased insulin sensitivity and impairment in insulin secretion, with a small incident increase in the risk of developing diabetes.

The potential benefits of using statin therapy for the prevention of cardiovascular disease significantly outweigh any of the potential risks associated with hyperglycemia.

5. Beta-Blockers

Nonvasodilating beta-blockers such as metoprolol and atenolol are more likely to be associated with increases in HbA1c, and are also associated with increased odds of hypoglycemia. People on beta-blockers may also have masking of some of the symptoms of hypoglycemia, such as tremor, irritability, and palpitations.

Education on recognizing and managing hypoglycemia is important when starting on beta-blockers if they are on preexisting insulin/sulfonylurea therapy. Use of CGM devices may also be helpful if there is a high risk for hypoglycemia, especially as symptoms of hypoglycemia are often masked.

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