Designed to relieve symptoms and improve quality of life, medications may cause unwanted side effects. Diabetes is one. The most prevalent cause of type 2 diabetes is insulin resistance. Some commonly used medications mimic this phenomenon. These drugs are referred to as "diabetogenic" drugs. Physicians may find it necessary to review medications when a patient has unexplained hyperglycemia or increases in glucose levels in the diabetics, because a number of drugs can cause hyperglycemia.
Thiazide Diuretics
Thiazide diuretics reduce high blood pressure. Some examples of thiazides include chlorothiazide (Diuril) and hydrochlorothiazide (Esidrix). They work by ridding the body of excess fluid. These medications treat conditions such as congestive heart failure, liver failure and corticosteroid and estrogen therapy. Hyperglycemia is a precaution associated with these drugs. Mechanisms involved in hyperglycemia caused by thiazides prove varied. Pandit and associates report decreased insulin sensitivity, increased hepatic glucose production, inhibition of secretion, and secretion of hormones known to cause. Patients on thiazides should be monitored for insulin resistance. It may become necessary for some patients receive temporary treatments of insulin.
B-blockers
B-blockers treat hypertension. Labetalol (Trandate) and propanalol are some examples of this class of drugs, reducing blood pressure in a dose related fashion. In addition to reducing hypertension, they cause diabetes by several mechanisms. Beta blockers prevent the release of insulin from the pancreas as well as reduce insulin sensitivity of tissues, more specifically, muscle. As a result, hyperglycemia occurs. In some cases, hyperosmolar coma has been induced according to Pandit and associates in the Annals of Internal Medicine. Patients on antidiabetic drugs may have their doses adjusted to accommodate the increase in glucose levels.
Corticosteroids
Corticosteroids can cause diabetogenics. Typically used to reduce inflammation, corticosteroids are dosed in inhaled form like fluticasone (Advair) and oral form prednisone (Deltasone). Long term use and large doses can lead to hyperglycemia or latent diabetes. In a review of the literature, Pandit and associates report, in addition to gluconeogenesis, corticosteroids my inhibit glucose uptake. As with beta-blockers, corticosteroids may cause non-ketotic hyperosmolar coma. This severe side effect of the drugs can result in high doses and if not monitored appropriately.
References
- Annals of Internal Medicine- Drug-Induced Disorders of Glucose Intolerance
- DailyMed-DIURIL (chlorothiazide) suspension [Salix Pharmaceuticals, Inc]
- DailyMed-TRANDATE (labetalol hydrochloride) tablet [Prometheus Laboratories Inc.]
- DailyMedDeltasone (prednisone) Tablet [Pharmacia and Upjohn and Company]
