Q. My husband is really struggling with high blood sugar. I suspect some of his medications may be causing it to stay up.
We are on a fixed income and his diabetes drugs are terribly expensive. We are having to choose between food or medicine. Any information you can offer would be welcome.
A. Many medications can make it hard to control blood sugar. Although this has been known for decades, health professionals may not always consider drug-induced diabetes when prescribing.
Statins and Diabetes: A Painful Paradox
Virtually all people with elevated blood sugar or a diagnosis of diabetes are being prescribed (thanks to American Heart Association Guidelines) statin-type cholesterol-lowering drugs. That means if a a doctor does not offer a medicine like atorvastatin, lovastatin, pitavastatin (Livalo), pravastatin, rosuvastatin (Crestor) or simvastatin, she could be dinged by her clinic or professional organization.
But here’s the rub: statins can actually trigger diabetes or make blood sugar control more challenging. Diabetes experts we have talked to downplay the risk. They are convinced that every person with diabetes must be on a statin even if it makes it harder to manage glucose levels. They just up the dose of diabetes medicine or add another medication to the mix.
We have always found that adding medicine to try and treat the side effects of a prior prescription somewhat counterproductive. That’s because each new medication adds complexity and a potential for additional complications. Here are a few case about statins and blood sugar:
This comes from Bob:
“I’m a numbers person – I pay attention. I noted a relatively sharp increase in blood glucose levels when I started taking simvastatin more than five years ago. I asked my doctor and he stated ‘the drug does more good than harm, keep taking it.’
“My morning FBG (fasting blood glucose) levels were on the rise (145ish). Accidentally I have forgotten to take my bedtime simvastatin for 4 to 5 nights. For the last 4 mornings, my glucose levels are all in the 120s; today 118. I haven’t seen these numbers in awhile now.
“It is pretty obvious that elevated glucose is harmful. I plan to resume tonight taking the simvastatin for 7 nights followed by a morning FBG reading. If my suspicions prove out, I will at the very least cut in half my simvastatin or possibly lose it all together.”
J. Hill wrote:
“I took simvastatin for 10 years. I was diagnosed as prediabetic after just 1 year and developed Type 2 diabetes after 4. As my cholesterol levels came down, my A1c went up, yet my doctor continued to INCREASE my simvastatin dosage, up to 80 mg.
“At that point, I was completely unable to control my blood sugars and had to start insulin injections. I developed severe leg pains, had difficulty concentrating, felt old and weak, and started stumbling when I walked.
“With the help and support of my chiropractor, I stopped taking simvastatin 18 months ago. As expected, my cholesterol levels went up (264). I now take herbal supplements, including Cholest-Off, vitamin D, fish oil, and turmeric, and my cholesterol is steadily coming down. I am no longer exhausted and in pain, and the best part is that my blood sugar is now under excellent control!
“One surprising development-my doctor is insistent that I try a different statin and has even enlisted the clinic’s pharmacist in calling and trying to persuade me–4 times just this year! I would rather die of a heart attack than take statins and live with blindness, amputations, and kidney dialysis.”
“I have been taking statins for years, first Lipitor and now Crestor. I developed diabetes, the only person in my family that has ever had it. I also have very little muscle strength. Of course my doctor insists that the statins have nothing to do with either one.”
Diuretics and Diabetes
Diuretics (“water pills” are among the most commonly prescribed drugs in America, but you might not even realize you are taking such a medication. That is because they are often added to other drugs to enhance blood pressure control. Common diuretics include: chlorthalidone (Hygroton, Thalitone ), chlorothiazide (Diuril), furosemide (Lasix) and indapamide (Lozol).
HCT or HCTZ: Hydrochlorothiazide (Esidrix, HydroDIURIL, Oretic)
This diuretic is found in so many combos it is mind boggling. Here is just a partial list:
Accuretic, Amturnide, Atacand HCT, Avalide, Benicar HCT, Benzepril/HCTZ, Bisoprol/HCTZ, Capozide, Diovan HCT, Dyazide, Exforge HCT, Hyzaar, Lopressor HCT, Lotensin HCT, Maxzide, Micardis HCT, Tekturna HCT, Triamterene/HCTZ, Vaseretic, Zestoretic and Ziac. If you see HCT or HCTZ in the name of your blood pressure medicine there is a very good chance it contains hydrochlorothiazide.
Although diuretics are perceived as super safe, elevations in blood glucose are not uncommon. By the way, diuretics can also increase cholesterol. So imagine this scenario: Someone has a mild case of hypertension and is put on a diuretic containing HCT. Blood sugar and cholesterol start to go up. Out comes a script for a statin (because anyone with elevated glucose must be on a statin). Now the double whammy of a diuretic and a statin could really increase the risk for type 2 diabetes.
Triple Whammy: Just Add Prednisone
If you really want to push someone over the edge, add a corticosteroid like prednisone to the mix. We wonder how many people are taking a statin plus a diuretic plus a drug like prednisone. If such a person does not end up with an elevated blood sugar level it would be amazing.
Shana shared her story of pure prednisone:
“I was first prescribed prednisone in 1985 at the age of 37 when I was diagnosed with severe asthma. My journey with this drug continued with very long and high dosages. I would be on for three weeks, off for two weeks and back on for how ever many weeks it took. This regime continued for at least 15 years when the asthma became controlled. At the 10 year mark, I was diagnosed with diabetes 2. Every time I take prednisone my blood sugar rises to a very high level.”
Diabetes Treatment Is Affordable!
We are emailing you our Guide to Managing Diabetes for a list of drugs (there are many more than those listed in this article) that can boost blood sugar. It also discusses a number of medicines used to treat type 2 diabetes (including generic metformin) and suggests nondrug approaches to help with blood glucose control.
Anyone else can download this guide for $2 from the website: www.peoplespharmacy.com.
It is certainly stressful to have to choose between the pharmacy and the grocery store. We suggest you explain the situation to the doctor and see if the medical team can find some ways to help you economize without jeopardizing your husband’s health.