Top 5 Drugs That Can Raise Blood Sugar Levels

This is the time of year when there are a ton of top 5 and top 10 lists on social media. Reviewing how different medications can have side effects beyond the disease state they are intended to treat might be a good idea, especially as we start a new year. Glycemic control disruption is one of the most frequent side effects of several drugs. Let's review some of the most popular drugs that are known to raise blood sugar levels and have a look at some useful strategies for avoiding them.

1. Glucocorticoids

Corticosteroids are unquestionably the most promising. To raise blood glucose levels. It is well established that high-dose glucocorticoid medication causes new-onset diabetes (steroid-induced diabetes). Similarly, upon starting glucocorticoid therapy, persons with preexisting diabetes may see a severe decrease of their glycemic control. The degree of glucose rise is determined by a number of factors, including their glycemic state before starting steroids, the dosage and length of glucocorticoid therapy, and coexisting medical disorders.

Management Tip

Metformin with or without sulfonylurea medication may be used to treat glucocorticoid-induced hyperglycemia in people with previously well-controlled diabetes or borderline diabetes, particularly if corticosteroid treatment is low-dose and administered for a shorter period of time. However, insulin therapy may be the preferred course of treatment for a large number of people who already have poorly managed diabetes or who were started on high-dose corticosteroids. In general, postprandial hyperglycemia caused by glucocorticoid medication is more noticeable than hyperglycemia caused by fasting; therefore, for many people, using short-acting insulin therapy or possibly NPH insulin in the morning may be a preferable alternative.

A key strategy for reducing the severity of postprandial hyperglycemia is dietary change. Using continuous glucose monitoring (CGM) devices can also be very beneficial in learning about glycemic excursions and determining the appropriate insulin dosage. When glucocorticoid therapy is tapered down for a patient, it's crucial to modify the dosage of drugs that can lower blood sugar, such insulin and sulfonylurea therapy, because a lower dose of the therapy can lessen the severity of hyperglycemia.

2. Antipsychotic Therapy

Antipsychotic drugs have the potential to cause obesity; among those using second-generation antipsychotics, 15% to 72% gain seven percent or more of their body weight. Type 2 diabetes is associated with a higher risk of development than only weight gain. Insulin resistance is hypothesized to be caused by antipsychotics downregulating intracellular insulin signaling. Additionally, there appears to be a direct impact on the beta cells in the pancreas.

Beta-cell sensitivity to blood glucose fluctuations is compromised by antagonistic interactions with the dopamine D2, serotonin 5-HT2C, and muscarinic M3 receptors. Antipsychotics have been demonstrated in cell culture tests to cause an increase in beta cell apoptosis in addition to their pharmacologic effects. Elevated body weight and concurrent onset of type 2 diabetes are observed specifically in medications with strong muscarinic M3 and histamine H1 receptor inhibition. medicines like ziprasidone have the least impact on glucose metabolism whereas medicines like clozapine, olanzapine, and haloperidol have the greatest.

Management Tip

A metabolically safer approach starts with medications that have a lower propensity for weight gain, and the partial agonists/third-generation antipsychotics as a family currently have the best overall data. This is because of the ongoing changes in our understanding of weight increases and their relationship to the risk of developing type 2 diabetes.

3. Thiazide Diuretics

Commonly used to treat hypertension, thiazide diuretics are linked to metabolic side effects such as hypokalemia, increased levels of triglycerides, cholesterol, and other circulating lipids, and raised glucose. These drugs which  lower potassium levels, believed that they  may be a factor in the development of new-onset diabetes. It is believed that the hypokalemia brought on by these drugs causes a dose-dependent reduction in insulin sensitivity and secretion. 29 over a year is the number needed to cause harm in cases of diabetes induced by chlorthalidone, indicated in the research. After a year, there is thought to be no further risk.

Management Tip

For patients who have started using thiazide diuretics, it's critical to keep an eye on potassium levels. If hypokalemia develops, it is important to treat it with potassium supplements in order to reduce the chance of developing diabetes at a young age.

4. Statin Therapy

It is believed that statin medication is linked to reduced insulin sensitivity and insulin secretion impairment. According to meta-analyses and population-based research, the total incidence of diabetes on statin medication is estimated to be between 9% and 12%. Overall, it is anticipated that 1 in 255 persons receiving statin medication for four years may experience new-onset diabetes, which is the number needed to harm. Compare this to the overwhelming evidence that the number of people with preexisting heart disease who require statin therapy for five years to prevent one nonfatal myocardial infarction is 39.

Management Tip

While there is a little incident increase in diabetes risk associated with statin medication, the potential benefits of statin therapy for primary and secondary cardiovascular disease prevention greatly exceed any potential hazards related to hyperglycemia. Having this crucial conversation with individuals who are hesitant to start statin therapy due to the possibility of developing new-onset diabetes as a side effect is critical.

5. Beta-Blockers

Another class of drugs that is frequently prescribed to treat arrhythmia, heart failure, hypertension, and coronary artery disease is beta-blockers. Compared to vasodilating beta-blockers like carvedilol, nebivolol, and labetalol, nonvasodilating beta-blockers like metoprolol and atenolol are more likely to be linked to increases in A1c, mean plasma glucose, body weight, and triglycerides (Bakris GL et al; Giugliano D et al). Studies have also demonstrated that, in comparison to carvedilol, atenolol and metoprolol are linked to higher risks of hypoglycemia. Certain symptoms of hypoglycemia, such as tremor, irritability, and palpitations, may be masking for those using beta-blockers, but other symptoms, including diaphoresis, may not be altered.

Management Tip

Management tip: If a patient is already receiving insulin or sulfonylurea therapy, it is crucial to educate them on identifying and treating hypoglycemia before initiating beta-blocker therapy. If there is a high risk of hypoglycemia, using a CGM device may be beneficial because hypoglycemia symptoms are frequently concealed.

Honorable Mention

Mechanistic target of rapamycin (mTOR) inhibitors, immunosuppressants, tyrosine kinase inhibitors, antiviral therapy, and interferon alpha are among the other drugs that have been linked to deteriorating glycemic control and new-onset diabetes. When administering these medications, take into account how they affect blood glucose, particularly in patients who already have diabetes or are at high risk of getting it.

Not to be overlooked is the use of androgen deprivation therapy. These include gonadotropin-releasing hormone (GnRH) agonist medicines like leuprolide and goserelin, which are frequently used to treat prostate cancer. These medications may be used for an extended period of time, depending on the patient. By definition, androgen deprivation therapy lowers men's testosterone levels, which exacerbates insulin resistance. The usage of these drugs has been linked to an increase in fat mass and concurrent muscle atrophy, which in turn causes peripheral insulin resistance. One in five men receiving long-term androgen deprivation therapy may be at risk of experiencing an A1c worsening of 1% or higher.

Management Tip

It is important to urge men undergoing androgen deprivation therapy to engage in regular physical activity as this can help lower the risk of insulin resistance and improve cardiovascular health.

In many circumstances, drug-induced diabetes has reversible potential. Similarly, in individuals with preexisting diabetes, the deterioration of glycemic control brought on by drugs may also lessen when the effects of the treatment wear off. Continuous monitoring of blood glucose is necessary to enable medication adjustments for diabetes. However, for some people, the deterioration of their glycemic state may be more persistent and necessitate the long-term use of antihyperglycemic medications; in these cases, the advantages of continuing the medicine that causes hyperglycemia greatly outweigh any possible hazards.

References: https://healthandfitnessdt.com/top-5-drugs-t5-that-can-raise-blood

Also Read: Special Considerations in Diabetes Mellitus

Hope you found this blog helpful for your NEET SS Endocrinology Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.