People with diabetes should take special precautions when taking medication because some of them can change blood sugar levels. There are medications that can raise blood sugar levels, while others can lower glycemic control at an alarming rate.
Antibiotics are one of the most well-known drugs that can lead to undesirable changes in blood sugar levels in anyone with type 2 diabetes, using oral hypoglycemic drugs. However, negative drug interactions are rarely seen in diabetics who use insulin to control blood sugar levels.
What are common problems marked by antibiotic therapy and oral hypoglycemic agents?
- seriously ill and elderly people are more likely to change their glycemic control compared with patients in the youth age group, and those who feel well despite an infectious disease.
- people with diabetes and tuberculosis, at the same time, have a higher refusal of treatment compared to nondiabetic. This is associated with a decrease in the concentration of rifampicin in the serum of people with diabetes, especially those with problems with their weight.
- Denial of treatment can also occur in people with obesity with diabetes, if the dosage is not calculated based on their weight.
What can delay the diagnosis of potential drug interactions?
Severely ill patients with systemic complications may have hypoglycemia or hyperglycemia, and this may lead to additional difficulties in diagnosing a possible drug interaction.
What are the most common antibiotics that can change blood sugar levels?
1. Fluoroquinolones :
- such as gatifloxacin, levofloxacin, ciprofloxacin and moxifloxacin, can lead to hypoglycemia and hyperglycemia in some patients, and in most cases a change in blood sugar level is dose dependent.
- can enhance insulin release from the pancreas, thereby reducing blood sugar levels.
Among fluoroquinolones, gatifloxacin has the most noticeable effect on blood sugar levels. Levofloxacin is next in line, so it may not be suitable for diabetics who have unstable blood sugar levels and those who are very sick. Ciprofloxacin may have the least effect on blood sugar control; therefore, it can be safely used for people with diabetes.
2. Macrolides (azithromycin, erythromycin and clarithromycin):
- clarithromycin, a type of macrolide, can increase the effect of repaglinide, causing an excessive decrease in blood sugar levels. To prevent this from occurring, the repaglinide dosage must be adjusted when using clarithromycin.
- macrolides may also increase serum sulfonylurea concentration, another type of oral hypoglycemic agent. Physicians should always consider reducing the sulfonylurea dose when a macrolide is also prescribed.
3. Rifampicin:
- rifampicin can significantly reduce the effect of certain oral hypoglycemic agents, such as nateglinide, rosiglitazone, pioglitazone, sulfonylurea and repaglinide, which leads to a decrease in the effect of these drugs. Therefore, when rifampicin is used in diabetics with tuberculosis, a higher dose of antidiabetic drug may be required.
4. Cephalexin:
- An increased concentration of metformin in the blood can be seen when taking cefalexin. However, the clinical significance of this problem is not yet known.
If you are given a new medicine and suddenly find that your blood sugar level is much higher or lower than normal, ask your doctor to check if the new medicine has a certain effect of lowering glucose or glucose levels.
