DRUGS AND HYPERGLYCEMIA

DRUGS AND HYPERGLYCEMIA

            Drug induced diabetes is defined as the new development of a hyperglycemic state that meets the definition of disease and that as due to the ingestion of a drug. The medication causing nondiabetic hyperglycemic states will be classified as causing drug induced diabetes. These offending drugs are grouped according to the mechanism by which they induce diabetes.

1. Drugs that cause diabetes by interfering with insulin production and secretion

b Receptor antagonist (propranolol)

Pyriminil (Vacor)

Pentamidine (Antiparasite in HIV pneumocystic carini)

Diphenylhydantoin (Anticonvulsant)

Tacrolimus

Didasoine

L-asparaginase (Antica in Leukamia)

Opiates

2. Drugs that causes diabetes by reducing the effectiveness (sensitivity) of insulin thus blocks insulin action

Glucocorticoids (Predinosolone >40mg/day)

Megasterol acetate

Oral contraceptives

b Receptor agonists (Solbutamol (Br. Asthma)

Growth hormone

Protease inhibitors

3. Drugs that interfere with both insulin secretion and insulin action

Thiazide diuretics

Cyclosporines (Immunosuppressants)

Diazoxide

A typical anti psychotic (Clonazepine Fluxodine)

4. Treatment that induces diabetes by increasing nutrient flux

Nicotinic acid (dyslipidemia)

Total parenteral nutrition (ICU setting)

1. Chronic use of b blocker (atenolol) with an increased risk for development of diabetes. b Receptor blockage inhibits insulin secretion by pancreatic islets in response to glucogone, glucose arginine. b Blocker antagonist exceeds the known two fold increase in risk for diabetes found in hypertensive population.
2. Glucocoticoids such as hydrocortisone, dexamethasone, prednisone and methylprednisone may induce diabetes. These drugs are used in a wide variety of disorders and in wide range of doses. The presence of an asymptomatic underlying genetic risk or metabolic disorder increase the risk for acute steroid induced diabetic 10 fold.
3. Thiazide diuretics, a commonly prescribed class of agents for control of hypertension, are often cited as causes of drug induced diabetes. Also hypertension itself increases the risk for developing diabetes by 2 fold or more. Thiazide therapy increased plasma insulin and decreased index of insulin sensitivity.
4. Nicotinic acid is an effective therapy for dyslipidemia. It is associated with increase level of blood glucose in both diabetic and non diabetics. Nicotinic acid induced hyperglycemia is an increase in hepatic glucose output due to enhanced gluconeogenesis, a diminished flow of FFAS to liver and diminished gluconeogenesis. Serum insulin levels increased, indicating an IR state. Also an intake of >3 drinks of alcohol per day is associated with 50% increased risk of diabetes.

Note:

            If possible drug which is suppose to have adverse effect on blood glucose level should be avoids in a patient of diabetes, prediabetes or IR syndrome.

REFERENCE:

            RSSDI Text Book of DM