Mr. Bao has been diagnosed with diabetes for 5 years. He is usually treated with oral medication, and his life is very regular. His blood sugar has been well controlled. Recently, he went to the dermatology clinic for herpes zoster, and the dermatologist decided to treat with dexamethasone. Mr. Bao adhered to the medication, but found that blood sugar remained high these days, fasting blood sugar up to 13mmol / L, so he went to the endocrinology clinic. The doctor analyzed that although the discomfort caused by herpes zoster caused blood sugar to fluctuate, the chief culprit for Mr. Bao’s blood sugar surge was dexamethasone. The doctor helped him adjust the hypoglycemic regimen, and he needed to re-establish the treatment plan after stopping dexamethasone.
Why does dexamethasone raise blood sugar? What other medications used to treat other diseases can affect blood sugar?
Today we will talk about those medicines that raise blood sugar.
In addition to dexamethasone used by Mr. Bao, there are prednisone, hydrocortisone, and cortisone acetate, which are commonly used in the treatment of rheumatism, blood diseases, severe skin allergies, and drug allergies. Nephrotic syndrome, chronic obstructive pulmonary disease, acute eye disease, etc., also require high-dose glucocorticoid shock therapy. These drugs directly act on hepatic glycogen and muscle glycogen, promote gluconeogenesis, and reduce the utilization of glucose by body tissues, leading to an increase in blood sugar. In general, the effect of glucocorticoids on blood sugar is transient and reversible, and as blood levels increase or decrease, blood sugar levels increase or decrease accordingly. The sugar friend must consult a doctor when using this medicine, and should be avoided as much as possible unless necessary.
★ blood pressure lowering medicine
Diuretics and beta blockers in antihypertensive drugs can affect the patient’s blood glucose levels. Thiazide diuretics, such as hydrochlorothiazide, have a greater effect on glucose tolerance and have a toxic effect on beta cells, leading to hypokalemia and inhibition of insulin secretion. Diabetic patients should try to avoid the use of thiazide diuretics. Beta blockers, such as Betaloc, induce blood sugar levels in the body by inhibiting insulin secretion and tissue utilization of glucose. Diabetic patients should also be used with caution.
★ hypolipidemic drugs
For example, niacin (also known as vitamin B3), while lowering blood lipids, increases insulin resistance and inhibits the utilization of glucose by tissues, thereby producing a certain effect of raising blood sugar. In addition, statins also have a tendency to cause elevated blood sugar while lowering cholesterol. This may be related to the fact that statins can damage the patient’s pancreatic beta cells and indirectly cause a decrease in insulin secretion.
For example, tacrolimus and cyclosporine A are used to prevent rejection after organ transplantation. After taking the drug, the incidence of hyperglycemia increased significantly. The mechanism is that it has a direct toxic effect on islet β cells, which reduces insulin secretion and causes hyperglycemia.
Chlorpromazine, haloperidol, trifluridol, clozapine, sulpiride, olanzapine, risperidone, etc., can cause insulin resistance in patients, reduce the reactivity of islet β cells, and cause blood sugar to rise. Among them, chlorpromazine has the most obvious effect on raising blood sugar.
Chemotherapy can cause abnormally elevated blood sugar, and severe cases can induce diabetes. In addition to glucocorticoids and sex hormones used in chemotherapy to raise blood sugar, chemotherapy drugs can also cause abnormal blood sugar. The direct and indirect toxicity of chemotherapeutic drugs may be the cause of abnormal blood glucose: platinum, asparaginase, methotrexate, cyclophosphamide and other direct toxic effects on islet β cells can inhibit the synthesis and secretion of insulin, resulting in Elevated blood sugar; impaired liver and kidney function caused by chemotherapy drugs, can indirectly interfere with blood sugar metabolism.
Such as nelfinavir, saquinone, indinavir, etc., after antiviral treatment and for a long time, may induce hyperglycemia. Patients should be tested for basal blood glucose levels between 3 months and 4 months before treatment and during the first year of treatment. If the blood sugar is stable, the number of tests can be gradually reduced.
In addition to the drugs listed above, anti-tuberculosis drugs such as isoniazid, rifampicin, amiodarone, thyroid hormones and other drugs can also cause elevated blood sugar. In addition, the fluoroquinolone antibiotic Gatifloxacin may also cause blood sugar levels to be disordered.
Many of the drugs mentioned above are commonly used by sugar friends, especially the antihypertensive drugs. Can you not use them? The answer is of course no, we can’t squander it because of it. As long as the sugar friends communicate with the specialists in a timely manner, assess the pros and cons, and closely monitor the changes in blood glucose during the use of the drug, these drugs that help control the disease can still be used.