Nine Drugs   (August 21, 2009)

I recently received an e-mail alerting me to a webpage discussing "9 Common Drugs That Every Diabetic Should Avoid Mixing With Their Meds." It was such an intriguing title that I Googled the phrase, and found that several websites had exactly the same list!

I totally disagree with the author's premise that people with diabetes (PWD) should avoid the medications on the list; in fact, all of these medications are reasonable for PWD to take, if their physician and/or pharmacist explains the issues involved.

Here's the original information (including some poor grammar and miscapitalizations), plus my comment for each:

Beta Blockers: Beta-blockers, such as Lopressor (metoprolol), Tenormin (Atenolol), and Inderal (propanolol), have been known to reduce the release of insulin.

The main concern for PWD with the use of beta-blockers, which are very useful drugs for the treatment of hypertension and heart disease, is that they might mask some of the symptoms of hypoglycemia. If you are prone to hypoglycemia, you could expect your usual symptoms relating to pounding heart and shakiness to be blunted while on beta-blockers.

Minoxidil: Minoxidil, a direct vasodilator, has a tendency to raise blood glucose levels.

See my comment after this list...

Thiazide Diuretics: Thiazide diuretics include such drugs as Diuril (Chlorothiazide), Zaroxolyn (Metolazone), and Oretic (Hydrochlorothiazide), and is known to raise glucose levels due to its effect it has on causing the loss of potassium.

See my comment after this list...

Calcium channel blockers: Calcium channel blockers, which are prescribed for Hypertension, management of Angina include such drugs as Calan (Verapamil), Adalat (Nifedipine),and Norvasc (Amlodipine), and is known to reduce the secretion of insulin.

I'm not sure where this information originated, or why someone considered it important enough to include in this list of medications. For instance, the USPI for Calan doesn't even mention the words insulin, diabetes, diabetic, glucose, or sugar. And the USPI for amlodipine states: "No clinically relevant changes were noted in serum glucose" and "Amlodipine besylate tablets have been used safely in patients with ... diabetes mellitus"

Oral contraceptives: Although current oral contraceptives seem to be safe, the older versions were known to have caused hypoglycemia when estrogen doses were taken at higher than normal doses.

See my comment after this list...

Corticosteroids: Even though corticosteroids can be used as a topical solution, it has a tendency to raise blood glucose levels.

I have written about PWD using steroid medications: Steroids and BG, and I pointed out that use of steroids is associated with rapid and sometimes dramatic increases in BG levels. But if there's no other therapy that's likely to work, and if the patient has been informed of the probable increase of blood sugar level, and if the doctor and the patient have a plan on how to cope with the increased blood sugar levels, they can be safely used in PWD.

Niacin: Niacin, which is a very common B vitamin and is suggested to lower cholesterol, it has been known to result in a hyperglycemic tendency within a person that has diabetes.

See my comment after this list...

Thyroid hormone: When levels of thyroid hormones are elevated, blood glucose levels are raised because of the reduction of insulin coming from the pancreas.

The author of this listing totally missed the point about thyroid hormone therapy. People with diabetes can and indeed must be treated with thyroid hormone if they have hypothyroidism (underactivity of the thyroid gland). The statement that elevated thyroid hormone levels cause elevated BG levels is true, but irrelevant unless the patient has been overdosed with thyroid hormone, or has a separate disorder, hyperthyroidism (overactive thyroid gland function).

Diphenylhydantoin: The common name for this drug is called Dilantin which is recommended to people to help control seizures. However, it also blocks the release of insulin.

Another name for this drug, not mentioned in the original article, is phenytoin. See my comment in the next paragraph...

Well, that's nine medications (or more strictly speaking, nine medications or classses of medications). It's my opinion that these drugs are perfectly reasonable for PWD to use, if there's a medical indication for them, and if the prescribing physician, the dispensing pharmacist, and most importantly you, are aware of the likelihood that they may affect your diabetes.

For most of these, the side effect will be to cause BG to rise. As I point out elsewhere, PWD should plan to check their BG for at least three days after any doctor changes any of your medications. That advice applies to these nine medications, and to any other new drug, whether prescription or over-the-counter.

For someone to make the absurd statement that these are "9 Common Drugs That Every Diabetic Should Avoid Mixing With Their Meds" is simply wrong, irresponsible, and balderdash.