Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-54

Corticosteroids

• Incidence of hyperglycemia/diabetes: 65%. • Anti-inflammatory and immunosuppressive agents (hydrocortisone, prednisone and dexamethasone) can cause hyperglycemia in people with and without diabetes. • Corticosteroids are associated with an increase in insulin resistance (up to 60%). • Mechanism: increased hepatic gluconeogenesis, inhibit glucose metabolism and uptake in peripheral/adipose tissue and impair insulin secretion. • Degree of hyperglycemia depends on the type and dose of medication, route of administration, duration of therapy and individual characteristics (variable effect). • Corticosteroids cause marked elevations in postprandial BG levels i.e. dose administered in the morning results in hyperglycemia mid-late afternoon and evening with minimal impact on FBG levels. BG returns to baseline within 24-48 hrs after last dose. • Incidence of hyperglycemia/diabetes: 11% • Long-term use of diuretics (chlorthalidone and thiazide) can increase the risk of hyperglycemia. The effect is dose dependent. • Mechanism: Decreased insulin secretion and insulin sensitivity. • Potassium supplementation may improve hyperglycemia. • Incidence of hyperglycemia/diabetes: 20-30%. • Used in the treatment of prostate cancer and increases risk of CV disease. • Mechanism: Lowers testosterone level and increases insulin resistance. • Incidence of hyperglycemia/diabetes: 22%. • Atypical antipsychotics are associated with a 3-4 fold increase risk of diabetes. This class of medications can increase blood glucose levels significantly in individuals with diabetes and those at risk of diabetes and/or cause an increase in BG levels. o Higher risk associated: olanzapine, clozapine, quetiapine. o Lower risk: risperidone, paliperidone, aripiprazole and ziprasidone. • Mechanism: Increased insulin resistance, medication-stimulated weight gain and neurotransmitter antagonism.

Diuretics

Androgen deprivation therapy

Atypical antipsychotics