Medications can be lifesaving; however, many have unwanted effects. Almost every drug class has medications that can affect blood sugars and even mask high and low glucose levels. From blood pressure meds to inhalers, steroids, antibiotics, antifungals and diuretics, the likelihood of you or someone you know using a drug that affects glucose levels.  There are too many to list. Below are just a few examples:

A few of the many drugs that increase blood sugar (hyperglycemia): (NIH database)

• Alcohol (decreases blood sugar after several hours of excessive intake)
• Antibiotics (Dapsone, Rifampin)
• Antidepressants (Zyprexa, risperdal, Clozaril, Seroquel, Abilify, Geodon, lithium)
• Beta-2 stimulators (Proventil, Alupent, Serevent, Foradil, Brethine, Theo-Dur)
• Corticosteroids (Prednisone, Decadron, DepoMedrol)
• Dilantin (phenytoin)
• Estrogens (Premarin, hormone replacement therapy)
• Fluconazole
• Heart and blood pressure medications (amiodarone, beta blockers(non insulin dependent diabetics), calcium channel blockers, catapress, diuretics)
• Oral contraceptives (Birth control pills)
• Niacin or nicotinic acid
• Thiazide diuretics
• Thyroid hormones (Synthroid, Levothroid)

If on a continuous glucose monitor acetaminophen (Tylenol) interferes with sensors resulting in a false low glucose reading and should be avoided.

A few of the drugs that decrease blood sugar (hypoglycemia): (NIH database)

• Alcohol (acute excess amounts)
• Aspirin and other salicylates in larger doses
• Cibenzoline and quinidine (heart arrhythmia drugs)
• Indomethacin (Indocin)
• Levofloxacin
• Trimethoprim-sulfamethoxazole
• Metformin when used with sulfonylureas
• Heart and blood pressure medications (ACE inhibitors, beta blockers, Norpace, Quinidine)

One common drug that masks low blood sugar

If diabetic (especially insulin dependent) and taking beta blockers the symptoms of low blood sugar may not be apparent. Beta blockers block the effects of norepinephrine. Norepinephrine, along with epinephrine are released into the bloodstream during hypoglycemic episode. In turn the release of these hormones causes the early symptoms of hypoglycemia such as tremor, sweating, rapid heartbeat, and anxiety. If diabetic and taking beta blockers monitor glucose levels closely even when you don’t have signs of low blood sugar.

Signs of low blood sugar (below 70 mg/dL or less)

Low blood sugar, especially in a diabetic, can be more dangerous and even a medical emergency if not treated in time.

Common signs of low blood sugar are:

• Fast heartbeat
• Shaking
• Sweating
• Nervousness or anxiety
• Irritability, anger or confusion
• Dizziness
• Hunger

During sleep, low blood sugar symptoms may include sweaty sheets and sometimes nightmares

Signs of severe low blood sugar (below 54 mg/dL or by symptoms listed below)- Medical emergency

• Loss of coordination
• Difficulty speaking or slurred speech
• Blurry or tunnel vision
• Inability to eat or drink
• Muscle weakness
• Drowsiness

If left untreated hypoglycemia can result in coma, seizures and in rare cases, death

Causes of Low Blood Sugar

There are many reasons why for low blood sugar, including:

• Taking too much insulin and/or not taking it on time
• Not eating enough carbs after taking insulin
• Poor diet- not eating a balanced protein, carbs and fat diet
• The amount and timing of physical activity.
• Drinking alcohol.
• Hot and humid weather.
• Unexpected changes in your schedule.
• Spending time at a high altitude.
• Going through puberty
• Menstruation
• On medication that causes low blood sugar
• Severe liver or kidney disease
• Severe infection
• Advanced heart disease
• Pancreatic or adrenal tumors
• Drinking alcohol at night

What to do if you or someone you know has low blood sugar. The CDC website has tips on managing and treating hypoglycemia:

The 15-15 Rule

For low blood sugar between 55-69 mg/dL, raise it by following the 15-15 rule:

Have 15 grams of carbs and check your blood sugar after 15 minutes. If it’s still below your target range, have another serving. Repeat these steps until it’s in your target range. Once it’s in range, eat a nutritious meal or snack to ensure it doesn’t get too low again.

These items have about 15 grams of carbs:

• 4 ounces (½ cup) of juice or regular soda.
• 1 tablespoon of sugar, honey, or syrup.
• Hard candies, jellybeans, or gumdrops (see food label for how much to eat).
• 3-4 glucose tablets (follow instructions).
• 1 dose of glucose gel (usually 1 tube; follow instructions).

Tips to keep in mind:

• It takes time for blood sugar to rise after eating. Give some time for treatment to work. Following the 15-15 rule helps.
• Young children usually need less than 15 grams of carbs, especially infants and toddlers. Ask your doctor how much your child needs.
• You should avoid eating a carbohydrate with lots of fiber, such as beans or lentils, or a carb that also has fat, such as chocolate. Fiber and fat slow down how fast you absorb sugar.
• Check your blood sugar often when lows are more likely, such as when the weather is hot or when you travel.

Treating Severely Low Blood Sugar- (below 55mg/dL)

Not treatable by 15-15-15 rule

Make sure your family members, friends, and caregivers know your signs of low blood sugar so they can help treat it if needed.

You also may not be able to check your own blood sugar or treat it by yourself, depending on your symptoms.

Injectable glucagon is the best way to treat severely low blood sugar. A glucagon kit is available by prescription. Speak with your doctor to see if you should have a kit. Be sure to learn how and when to use it. Let family members and others close to you know where you keep the glucagon kit and make sure they’ve been trained in how to use it too.

It’s important to contact a doctor for emergency medical treatment immediately after receiving a glucagon injection. If a person faints (passes out) due to severely low blood sugar, they’ll usually wake up within 15 minutes after a glucagon injection. If they don’t wake up within 15 minutes after the injection, they should receive one more dose.

When the person is awake and able to swallow:

• Feed the person a fast-acting source of sugar (regular soft drink or fruit juice).
• Then, have them eat a long-acting source of sugar (crackers and cheese or a sandwich with meat).
• It’s also important that friends, family, co-workers, teachers, coaches, and other people you may be around often know how to test your blood sugar and treat severely low blood sugar before it happens.

A medical ID, usually a bracelet or necklace, can be critical in keeping you safe and healthy. Emergency medical technicians are trained to look for a medical ID when caring for someone who can’t speak for themselves.

When To Call 911

If any of the following happens, your friend, relative, or helper should call 911:

• You pass out and no glucagon is available.
• You need a second dose of glucagon.
• You had glucagon but are still confused.
• Your blood sugar stays too low 20 minutes after treatment or doesn’t respond to your usual treatments.
• Or call 911 anytime you are concerned about your severely low blood sugar.

After You Have Low Blood Sugar

If your low blood sugar was mild (between 55-69 mg/dL), you can return to your normal activities once your blood sugar is back in its target range.

After you have low blood sugar, your early symptoms for low blood sugar are less noticeable for 48 to 72 hours. Be sure to check your blood sugar more often to keep it from getting too low again, especially before eating, physical activity, or driving a car.

If you used glucagon because of a severe low (54 mg/dL or below), immediately call your doctor for emergency medical treatment. If you have had lows several times close together (even if they’re not severe), you should also tell you doctor. They may want to change your diabetes plan.

(This is part 1 of a series on diabetes, other parts will delve into labs, testing, prevention and management of diabetes)

A recent study revealed that Thai farmers exposed to different pesticides found an association between 3 different pesticides and onset of type 2 diabetes.

According to the study, a population-based case-controlled study was conducted among residents in the Bang Rakam district of Phitsanulok Province in Thailand. Lifetime pesticide exposure and other relevant data were collected from 866 participating cases with diabetes mellitus and 1021 healthy controls. Among 35 individual brand-named pesticides investigated, they found statistically significant occurrences of type 2 diabetes with three insecticides.

3 Pesticides

A popular insecticide, trade name Sevin, (carbaryl) recently banned for homeowner use but still available for commercial application was found to have a casual association to the onset of type 2 diabetes, along with other health issues. This insecticide was pulled from consumer shelves mid 2020 but is still used on industrial crops. Another insecticide, mevinphos has been on the EPA restricted use list, but is banned in the EU, and endosulfin whiles still being used on U.S. crops is being phased out globally.

In addition, another popular pesticide, Roundup (glyphosate) may also contribute to type 2 diabetes according to a 2022 study titled “Impact of Glyphosate on the Development of Insulin Resistance in Experimental Diabetic Rats: Role of NFκB Signalling Pathways”.

What is diabetes?

Diabetes is a chronic, serious health issue facing over 10 percent of the U.S. population, and one in five people with diabetes don’t even know they have it. It is a leading cause of death due to complications, such as heart disease, stroke, blindness, kidney failure and lower limb amputation. Depending on the type of diabetes, insulin and glucose metabolism are involved.  While the link between pesticide use is a contributing factor, many other life choices and genetics play into the development of diabetes.

All diabetes is diagnosed through bloodwork, by checking glucose readings- either fasting, after meals or both. A urine dip can show high glucose levels, indicating the need for further testing via bloodwork.

Types of Diabetes

Prediabetes

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Approximately 96 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% don’t know they have it. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

Insulin is key factor

 Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into cells for use as energy. If you have prediabetes, the cells in your body don’t respond normally to insulin. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes—and type 2 diabetes down the road.

Insulin, Blood Sugar, and Type 2 Diabetes

• Insulin is a key player in developing type 2 diabetes. This vital hormone—you can’t survive without it—regulates blood sugar (glucose) in the body, a very complicated process. Here are the high points:
• The food you eat is broken down into blood sugar.
• Blood sugar enters your bloodstream, which signals the pancreas to release insulin.
• Insulin helps blood sugar enter the body’s cells so it can be used for energy.
• Insulin also signals the liver to store blood sugar for later use.
• Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
• Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you haven’t eaten for a while.
• That’s when everything works smoothly. But this finely tuned system can quickly get out of whack, as follows:
• A lot of blood sugar enters the bloodstream.
• The pancreas pumps out more insulin to get blood sugar into cells.
• Over time, cells stop responding to all that insulin—they’ve become insulin resistant.
• The pancreas keeps making more insulin to try to make cells respond.
• Eventually, the pancreas can’t keep up, and blood sugar keeps rising.
• Lots of blood sugar in the bloodstream is very damaging to the body and needs to be moved into cells as soon as possible. There’s lots of insulin, too, telling the liver and muscles to store blood sugar. When they’re full, the liver sends the excess blood sugar to fat cells to be stored as body fat. Yep, weight gain. And what’s more serious, the stage is set for prediabetes and type 2 diabetes.

NOTE: Type 1 diabetes is different; it’s thought to be caused by an autoimmune reaction (the body attacks itself by mistake). People with type 1 diabetes don’t make enough insulin and need to take it to survive.

Symptoms

(Type 2 diabetics)

• Urinate (pee) a lot, often at night
• Are very thirsty
• Lose weight without trying
• Always hungry
• Blurred vision
• Have numb or tingling hands or feet
• Fatigue
• Dry skin
• Slow healing sores or injuries
• Have more infections than usual

You’re at risk for type 2 diabetes if you:

• Have prediabetes.
• Are overweight.
• Are 45 years or older.
• Have a parent, brother, or sister with type 2 diabetes.
• Are physically active less than 3 times a week.

Treatment

Treatment consists of leading a healthy lifestyle, diet, and sometimes oral medications.

Type One Diabetes

Type 1 diabetes is a disease in which autoimmune destruction of pancreatic β-cells leads to insulin deficiency.

If you have type 1 diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin helps blood sugar enter the cells in your body for use as energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes.

Type 1 diabetes was once called insulin-dependent or juvenile diabetes. It usually develops in children, teens, and young adults, but it can happen at any age.

Only 5-10% of people with diabetes have type 1. Currently, no one knows how to prevent type 1 diabetes, but it can be treated successfully by:

• Following your doctor’s recommendations for living a healthy lifestyle.
• Managing your blood sugar.
• Getting regular health checkups.
• Getting diabetes self-management education and support.

Symptoms

In addition to the above symptoms listed for type 2 diabetes, type 1 diabetics may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe.

Treatment

Treatment consists of insulin therapy and sometimes oral medication in addition to leading a healthy lifestyle.

Gestational diabetes

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

What Causes Gestational Diabetes?

Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

• Having gestational diabetes can increase your risk of high blood pressure during pregnancy. It can also increase your risk of having a large baby that needs to be delivered by cesarean section (C-section).
• If you have gestational diabetes, your baby is at higher risk of:
• Being very large (9 pounds or more), which can make delivery more difficult
• Being born early, which can cause breathing and other problems
• Having low blood sugar
• Developing type 2 diabetes later in life
• Your blood sugar levels will usually return to normal after your baby is born.
• About 50% of women with gestational diabetes go on to develop type 2 diabetes. You can lower your risk by reaching a healthy body weight after delivery.

Who is at risk

• Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds
• Overweight
• Over age of 25
• Not physically active

Symptoms

Unlike type 1 and 2 diabetes, there usually aren’t symptoms, it is usually diagnosed by urine and bloodwork.

Treatment

Depending on the severity of the diabetes, medication, lifestyle, and diet changes may be implemented.