Non-diabetic medications causing hyperglycemia or hypoglycemia

Assoc. Prof. Dr. Hoang Trung Vinh – Vietnam Military Medical Academy

Medications that may induce hyperglycemia

No.	Drug Class/Name	Mechanism/Impact	Measures to mitigate hyperglycemic effects
1	Corticosteroids – Prednisolone – Dexamethasone – Methylprednisolone	– Increase hepatic gluconeogenesis – Decrease insulin sensitivity – Primarily increase postprandial glucose	– Use the lowest dose for the shortest duration (if possible) – Take in the morning (to reduce nocturnal glucose elevation) – Prioritize topical use: inhalation, ointment (if possible) – Monitor postprandial glucose – Temporary short-term insulin use (if necessary)
2	Diuretics – Hydrochlorothiazide – Furosemide	– Decrease insulin secretion due to hypokalemia – Increase insulin resistance	– Monitor serum potassium – Potassium supplementation if necessary – Consider switching to another suitable drug class if possible
3	Antipsychotics – Olanzapine – Clozapine – Risperidone	– Weight gain – Severe insulin resistance – Risk of new-onset diabetes	– Prioritize medications with less metabolic impact (if possible) – Monitor glucose and weight – Promote physical activity and dietary restriction
4	Immunosuppressants – Tacrolimus – Cyclosporine	– Pancreatic beta-cell toxicity reducing insulin secretion – Decrease cell growth	– Regular glucose monitoring – Adjust dose based on drug concentration – Coordinate with endocrine therapy when necessary
5	Beta-blockers – Propranolol – Atenolol	– May cause mild glucose elevation, decrease insulin secretion – Mask symptoms of hypoglycemia (very dangerous)	– Replace with highly selective beta-blockers such as: Metoprolol, Carvedilol, Nebivolol
6	Sympathomimetics Salbutamol	– Increase glycogenolysis causing hyperglycemia – Increase gluconeogenesis – Stimulate free fatty acid release	– Avoid high doses if possible – Prioritize inhalation route – Use intermittently if possible
7	Oral contraceptives: Estrogen ± Progestin (Ethinylestradiol)	– Increase insulin resistance – Increase hepatic glucose production – Decrease insulin sensitivity – Impair glucose tolerance	– Choose products with low estrogen content (< 35 mcg) or prioritize progestin-only pills (POP) – Consider non-hormonal contraception: condoms, IUDs – Periodic glucose monitoring
8	Other medications
	Phenytoin	Decrease insulin secretion	Dose adjustment (reduction) or medication replacement
	Niacin (Vitamin B3)	Increase insulin resistance	– Titrate dose slowly – Use extended-release formulations (Niaspan) – Take with meals
	Interferon	Induce autoimmune diabetes	– Dose adjustment (reduction) – Use insulin if hyperglycemia is prolonged – Periodic glucose monitoring

 

Medications that may induce hypoglycemia

No.	Drug Class/Name	Mechanism/Impact	Measures to mitigate hyperglycemic effects
1	Antibiotics – Quinolones: Levofloxacin, Ciprofloxacin – Sulfonamides: Trimethoprim / Sulfamethoxazole	– Increase insulin secretion – Increase insulin sensitivity	– Avoid use if alternatives exist (especially in elderly or diabetic patients) – Do not use concurrently with potent hypoglycemic agents (if possible) – Monitor glucose during treatment
2	Antimalarials: Quinine	Stimulate insulin secretion causing severe hypoglycemia	– If IV, must be infused slowly – Should be diluted with dextrose solution – Switch to oral route as soon as possible – Avoid excessively high doses – Periodic glucose monitoring
3	Cardiovascular drugs – Propranolol – ACE inhibitors (Enalapril)	– Increase insulin sensitivity (ACEI) – Mask hypoglycemia symptoms (Beta-blockers)	– Select selective beta-blockers (less impact) – Reduce dose of antidiabetic medications – Consider switching to Angiotensin II Receptor Blockers (ARBs)
4	Pentamidine (Antimicrobial for pneumonia)	– Initial phase causes hypoglycemia due to excessive insulin release. – Subsequent phase causes hyperglycemia due to cell destruction.	– Frequent glucose monitoring, ideally continuous (CGM). – Replace with aerosolized form.
5	Analgesics – Anti-inflammatory – High-dose Aspirin – Ibuprofen – Diclofenac – Naproxen	– Increase insulin sensitivity – Interaction with antidiabetic drugs (SU) – Inhibit Prostaglandins – substances involved in glucose regulation	– Use low doses or avoid in diabetic patients if possible – Use alternatives like Paracetamol – Avoid prolonged use – Adjust antidiabetic drug dosage appropriately

 

General measures in clinical practice

– Thoroughly investigate adverse effects and drug interactions when glucose levels show unexplained fluctuations.
– Identify medications with the risk of inducing hyperglycemia/hypoglycemia.
– Timely adjust medications suspected of causing glucose fluctuations: Dose adjustment, especially for insulin.
– Individualize patient care:
+ Elderly patients: High risk of hypoglycemia.
+ Patients with liver/kidney disease: Reduced metabolism and elimination, increasing the risk of hypoglycemia.
– Regularly monitor glucose, including continuous monitoring (CGM if available), especially with high-dose corticosteroids or in severe clinical conditions.
– Dietary adjustment: Avoid rapid-acting sugars, use small frequent meals, do not skip meals.
– Patient education: Recognize signs of hyperglycemia/hypoglycemia, always carry rapid-acting sugar for emergencies (glucose tablets, candy).

 

REFERENCES

1. Vasu, T. P., & Molitch, M. E. (2024). Medication-induced hyperglycemia and diabetes mellitus: A review of current literature and practical management strategies. Journal of Clinical Medicine, 13(16), Article 4834. https://doi.org/10.3390/jcm13164834
2. Faillie, J.-L. (2024). Drug-induced hyperglycemia and diabetes. Therapie, 79(2), 145–152. https://doi.org/10.1016/j.therap.2023.10.005
3. Swenson, A. J., Smith, K. L., & Roberts, R. E. (2025). Non-diabetic hypoglycemia: Evaluation and management in adults. Journal of Clinical Medicine, 14(1), Article 4393. https://doi.org/10.3390/jcm14014393