Top 5 Medications That Can Increase Blood Glucose Levels

1. Glucocorticoids Corticosteroids are the top contenders for raising blood glucose levels. High-dose glucocorticoid therapy can cause steroid-induced diabetes. People with existing diabetes may experience a significant worsening of glycemic control when starting glucocorticoid therapy. The increase in glucose depends on their glycemic status before starting steroids, the dose and duration of therapy, and other factors.

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Tip: If someone has well-controlled or borderline diabetes, metformin with or without sulfonylurea therapy can manage glucocorticoid-induced hyperglycemia, especially for low-dose and short-term treatments. For poorly controlled diabetes or high-dose corticosteroids, insulin therapy might be the preferred choice. Glucocorticoid therapy often leads to more postprandial hyperglycemia, so using short-acting insulin or NPH insulin in the morning may be better. Dietary changes and continuous glucose monitoring can also help manage hyperglycemia. Adjust medications causing hypoglycemia when tapering down glucocorticoid therapy.

1. Antipsychotic Therapy Second-generation antipsychotics can cause weight gain in 15% to 72% of users. Weight gain isn't the only risk; antipsychotics may downregulate insulin signaling, causing insulin resistance and affecting pancreatic beta cells. Some agents like clozapine, olanzapine, and haloperidol have a higher impact on glucose metabolism.

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Tip: Choosing antipsychotics with lower weight gain potential, like partial agonists/third-generation antipsychotics, is a metabolically safer approach.

1. Thiazide Diuretics Thiazide diuretics, used for hypertension, may lead to hypokalemia and increased glucose levels. Reduced potassium levels can decrease insulin secretion and sensitivity.

Tip: Monitor potassium levels and consider potassium supplements if hypokalemia occurs to mitigate the risk of new-onset diabetes.

1. Statin Therapy Statin therapy is associated with decreased insulin sensitivity and a 9-12% incidence of diabetes. The benefits of statin therapy for cardiovascular health outweigh the small risk of hyperglycemia.

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Tip: Discuss the potential risk of new-onset diabetes with patients reluctant to use statin therapy.

1. Beta-Blockers Nonvasodilating beta-blockers like metoprolol and atenolol may increase A1c, body weight, and triglycerides compared to vasodilating beta-blockers like carvedilol.

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Tip: Educate patients on recognizing and managing hypoglycemia when starting beta-blockers, especially for those on insulin/sulfonylurea therapy.

Consider the effects of other medications on blood glucose, especially in those at risk of diabetes. Androgen deprivation therapy for prostate cancer may worsen insulin resistance.

Tip: Encourage physical activity for men on androgen deprivation therapy to reduce insulin resistance and promote cardiovascular health.

Drug-induced diabetes may be reversible, and monitoring blood glucose can help adjust medications accordingly. For some, long-term antihyperglycemic agents may be necessary.