Are there medications that can raise blood sugar levels?

Medications That Raise Blood Sugar

Several common medications can significantly raise blood sugar levels, including glucocorticoids, thiazide diuretics, beta-blockers, second-generation antipsychotics, and certain statins. Understanding these medications is crucial for proper diabetes management and prevention of hyperglycemia.

Glucocorticoids (Steroids)

Glucocorticoids are among the most potent medications that elevate blood glucose:

• Mechanism: They increase insulin resistance, enhance hepatic gluconeogenesis, and impair insulin secretion 1
• Impact: Can cause significant hyperglycemia, particularly during the day with morning doses
• Management approach: For patients on steroids like prednisone, NPH insulin is recommended to be administered concomitantly with intermediate-acting steroids due to matching peak action times (4-6 hours) 1
• Monitoring: Daily blood glucose adjustments are necessary based on glycemic levels and anticipated changes in steroid dosing 1

Antihypertensive Medications

Different classes of antihypertensive medications have varying effects on blood glucose:

• Thiazide diuretics: Consistently associated with increased risk of hyperglycemia 2
• Beta-blockers: Both non-selective (propranolol) and beta-1 selective (metoprolol) can increase basal blood glucose values 3
• Better alternatives: Calcium channel blockers and inhibitors of the renin-angiotensin system have less impact on blood glucose 2

Antipsychotic Medications

Second-generation antipsychotics significantly impact glucose metabolism:

• High-risk agents: Olanzapine, clozapine, quetiapine, and risperidone tend to have more pronounced metabolic effects 1
• Lower-risk options: Aripiprazole and ziprasidone have fewer metabolic effects 1
• Screening protocol: Patients on these medications should be screened for prediabetes/diabetes at baseline, 12-16 weeks after medication initiation, and annually thereafter 1

Other Medications That Raise Blood Sugar

• Statins: May induce hyperglycemia, with effect varying by type and dose 2
• Fluoroquinolones: Can cause severe hyperglycemic events, especially at high doses 2
• Calcineurin inhibitors: Cause hyperglycemia primarily by decreasing insulin secretion 2
• HIV medications: Antiretroviral therapies, particularly protease inhibitors, can alter glucose metabolism 1, 2
• Phenytoin and valproic acid: May induce hyperglycemia 2
• mTOR kinase inhibitors (e.g., everolimus): Interfere with insulin signaling, leading to impaired insulin secretion and increased insulin resistance 1

Drug Interactions That Affect Blood Glucose

Some medications can potentiate the effects of diabetes medications:

• Metformin interactions: Drugs that reduce metformin clearance (e.g., ranolazine, vandetanib, dolutegravir, cimetidine) can increase systemic exposure to metformin 4
• Insulin/sulfonylurea interactions: When combined with other medications, may require dose adjustments to prevent hypoglycemia 4

Clinical Implications and Monitoring

For patients at risk:

• Regular monitoring: Blood glucose should be monitored frequently when starting or adjusting doses of these medications
• For steroid injections: Diabetic patients should monitor blood glucose levels for up to a week after injection, as peak increases may be delayed by several days 5
• For transplant patients: Special consideration is needed as they often require multiple medications that can affect glucose metabolism 1

Prevention Strategies

When prescribing potentially diabetogenic medications:

1. Risk assessment: Evaluate baseline diabetes risk before initiating therapy
2. Medication selection: Choose alternatives with less impact on glucose metabolism when possible
3. Monitoring protocol: Establish appropriate glucose monitoring based on medication risk
4. Early intervention: Consider metformin for mTOR inhibitor-induced hyperglycemia 1

Understanding these medication effects is essential for clinicians to properly manage patients with diabetes or those at risk for developing hyperglycemia while on necessary treatments.