Drugs that raise blood sugar
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Drugs That Raise Blood Sugar: A Comprehensive Overview
Introduction to Drug-Induced Hyperglycemia
Drug-induced hyperglycemia is a significant global health issue, as it can lead to severe complications such as microvascular and macrovascular diseases, infections, metabolic coma, and even death. Various medications can increase blood sugar levels through different mechanisms, including altering insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells, and increasing glucose production 1.
Antihypertensive Drugs and Blood Sugar Levels
Among antihypertensive drugs, thiazide diuretics and certain beta-blockers are more frequently associated with increased serum glucose levels compared to calcium-channel blockers and inhibitors of the renin-angiotensin system 1. Studies have shown that both cardioselective beta-blockers like metoprolol and non-selective beta-blockers like propranolol can raise blood sugar levels in diabetic patients, although the increase is generally small and manageable with careful monitoring 7.
Lipid-Modifying Agents and Hyperglycemia
Lipid-modifying agents, particularly statins, have been reported to induce hyperglycemia, with the diabetogenic effect varying between different types and doses of statins. Nicotinic acid is another lipid-modifying agent that can alter glycemic control 1. Additionally, a notable interaction between the lipid-lowering agent pravastatin and the antidepressant paroxetine has been found to synergistically increase blood glucose levels significantly 3.
Anti-Infectives and Blood Sugar
Certain anti-infective drugs, such as fluoroquinolones, can cause severe hyperglycemia, especially at high doses. Protease inhibitors and nucleoside reverse transcriptase inhibitors used in HIV treatment have also been reported to alter glucose metabolism 1.
Psychotropic Drugs and Blood Glucose
Second-generation antipsychotics are known to cause hyperglycemia, diabetes mellitus, and ketoacidosis primarily due to insulin resistance. Among antipsychotics, olanzapine has been associated with a significant increase in blood glucose levels compared to other drugs like ziprasidone, lurasidone, and risperidone 9. Additionally, chlorpromazine has been linked to an increased prevalence of diabetes in hospitalized psychotic patients 4.
Steroids and Chemotherapeutic Agents
High doses of glucocorticoids are frequently associated with steroid-induced diabetes. Some chemotherapeutic agents also carry a higher risk of hyperglycemia, and calcineurin inhibitors mainly cause hyperglycemia by decreasing insulin secretion 1.
Hormonal Therapies and Blood Sugar
Oral contraceptives containing high doses of estrogen, growth hormone therapy, and somatostatin analogues can induce hyperglycemia. These hormonal therapies can significantly impact glycemic control and should be monitored closely 1.
Other Notable Drugs
- Glucagon and Diazoxide: These drugs are used to treat hypoglycemia but can raise blood glucose levels as a side effect 2.
- Liraglutide and Exendin-4: Although used to treat diabetes, these GLP-1 receptor agonists can paradoxically increase blood glucose levels in certain conditions, such as high doses or acute administration 56.
Conclusion
A wide range of drugs can induce hyperglycemia through various mechanisms. Clinicians must be aware of these potential side effects and monitor patients closely, especially those with pre-existing diabetes or at high risk for developing diabetes. Understanding the specific drugs and their mechanisms can help in managing and mitigating the risks associated with drug-induced hyperglycemia.
Sources and full results
Most relevant research papers on this topic
Drug-Induced Hyperglycaemia and Diabetes
Drug-induced hyperglycemia and diabetes can be a serious issue, with various medications posing a risk, and clinicians should be aware of potential risks and closely monitor patients.
Highly CitedPharmacological control of blood sugar
Lowering blood glucose is the main treatment for diabetes, with various drugs affecting blood sugar to treat type 1, type 2, and non-insulin dependent diabetes.
Detecting Drug Interactions From Adverse‐Event Reports: Interaction Between Paroxetine and Pravastatin Increases Blood Glucose Levels
Pravastatin and paroxetine together can increase blood glucose levels, a potential side-effect not generally associated with combined therapy with SSRIs and statins.
Observational Study
Rigorous JournalHighly CitedThe effects of psychotropic drugs and diuretics on blood glucose levels in diabetes mellitus.
Antidepressants can lower blood glucose levels in diabetics, while diuretics and tranquilizers can raise them, potentially increasing the prevalence of diabetes in hospitalized psychotics.
Bolus Injection of Liraglutide Raises Plasma Glucose in Normal Rats by Activating Glucagon-like Peptide 1 Receptor in the Brain
Liraglutide temporarily increases blood glucose in normal rats by activating the glucagon-like peptide-1 receptor in the brain, with cross-tolerance observed between the two drugs.
Non-RCT
Animal StudyExendin-4 increases blood glucose levels acutely in rats by activation of the sympathetic nervous system.
High doses of Exendin-4 can paradoxically increase blood glucose levels in rats, indicating that its effects on glucose metabolism may be influenced by sympathetic nervous system activation.
Non-RCTAnimal StudyBeta-adrenoceptor-blocking drugs and blood sugar control in diabetes mellitus.
Beta-blockers can improve blood sugar control in non-insulin-dependent diabetics, with propranolol showing a slightly greater rise in blood sugar than metoprolol.
Highly CitedEffect of Antihyperglycemic Agents Added to Metformin and a Sulfonylurea on Glycemic Control and Weight Gain in Type 2 Diabetes: A Network Meta-analysis
Adding a third antihyperglycemic drug to patients with type 2 diabetes who are already receiving metformin and a sulfonylurea does not show clear differences in benefit between drug classes.
Meta-AnalysisHighly CitedThe metabolic side effects of 12 antipsychotic drugs used for the treatment of schizophrenia on glucose: a network meta-analysis
Olanzapine is associated with significantly higher blood glucose levels than other antipsychotic drugs, helping clinicians tailor drug choices to individual patient needs.
Meta-AnalysisRigorous JournalHighly CitedVasoactive drugs enhance pancreatic islet blood flow, augment insulin secretion and improve glucose tolerance in female rats.
Pravastatin, irbesartan, and captopril improve glucose tolerance in female rats by selectively controlling pancreatic islet blood flow and enhancing insulin secretion.
Non-RCTAnimal Study