Selasa, 23 Mei 2017

corticosteroids list

corticosteroids list

hello, i am ty mason of,researcher, writer and i have type 2 diabetes. today i want discuss drugs that raise bloodsugar levels. after you watch the video today, i inviteyou check out the description box for my new ebook. this is one of the most comprehensive diabetesmeal planning book you can find. it contains diabetes friendly meals/recipes,recipes for different goals such as 800-1800 calories per day meal plan, diabetes mealplanning tips and tricks. there are also tons of diabetes friendly recipesfor everyone! we all get sick from time to time.

we all have been given prescriptions otherthan our metformin or insulin. but did you know some medications can raiseyour blood sugar? i am confident that somewhere in that plethoraof literature that accompanies most prescriptions is information that says that the drug willaffect blood sugar. but how many of us actually read all thatliterature? today i want to talk about common drugs thatcan raise your blood sugar. this list was compiled after researching thework of mark t. marino, md. corticosteroidsone class of medicines that has been shown to raise glucose levels is called the glucocorticoids.

this includes such drugs as prednisone, dexamethasone,and triamcinolone. these drugs are called glucocorticoids becausethey have a profound effect on carbohydrate metabolism. they also have very powerful anti-inflammatoryeffects and are usually reserved for serious medical conditions that require a substantialreduction in inflammation, such as rheumatoid arthritis, severe asthma, or inflammatorybowel disease. corticosteroids counteract the effect of insulinon the liver and stimulate the production of glucose. they also block the entry of glucose intothe muscles and fat tissue by preventing glucose-transport

proteins in the cells of those tissues fromreaching the cell membrane, where they normally serve to remove glucose from the blood. these drugs have many other serious side effects,including osteoporosis, suppression of the adrenal glands, and cataracts. for these reasons, they are only used whenthe possible benefits outweigh the risks. many of these drugs are now available in aninhaled form for asthma or an intranasal form for allergies. these forms of delivery are associated withfar fewer side effects than oral forms, including those related to the body’s use of glucose.

thiazide diureticshigh blood pressure is itself a significant risk factor for type 2 diabetes, but someof the drugs used to treat it also appear to raise the risk of developing diabetes. thiazide diuretics are a class of drugs thattreat high blood pressure by blocking the reabsorption of sodium in the kidneys. as part of this process, potassium is alsolost in the urine. this results in a lower level of potassiumin the blood, a condition known as hypokalemia. many people who take this type of blood-pressure-loweringdrug also need to take potassium supplements to keep their blood levels of potassium inthe normal range.

as noted earlier, potassium levels are closelylinked with both insulin secretion and glucose uptake into muscle and fat tissue. multiple studies have looked at the effectof thiazide diuretics on blood glucose levels, and the majority suggest that these drugstend to raise blood glucose. the most recent study was allhat (antihypertensiveand lipid-lowering treatment to prevent heart attack trial). in this trial, whose results were publishedin 2006, participants were given one of several different types of medicine to treat theirhigh blood pressure, to try to determine the best type of therapy.

based on a subgroup analysis of approximately18,000 people without diabetes who were treated and followed for an average of five years,the risk of developing diabetes was slightly higher in those who took a thiazide diuretic(14%) compared to those who took two other types of blood-pressure-lowering drugs, acalcium channel blocker (11.1%) or an angiotensin-converting enzyme (ace) inhibitor (9.5%). while this difference may seem small, whenthese percentages are applied to the millions of people with high blood pressure, many morewill develop diabetes on a thiazide diuretic than on a different type of drug. however, choosing a drug to treat high bloodpressure is not a simple issue, since allhat

also showed that thiazide diuretics were superiorto or equally as effective as other classes of blood-pressure-lowering drugs in peoplewith diabetes. when allhat investigators specifically lookedat study participants who had diabetes, they found that these people tended to do wellon thiazide diuretics but also had, on average, a small increase in blood glucose (5 mg/dl). many other large studies have also noted thiseffect. the risk of developing diabetes while takinga thiazide diuretic was also evaluated in the nurses’ health study i and ii as wellas the health professionals follow-up study. between the two studies, a total of 74,816people who initially did not have diabetes

were evaluated. over the course of treatment with a thiazidediuretic, the risk of developing diabetes was 20% higher in older women (average age62), 51% higher in younger women (average age 40), and 31% higher in men compared tothose in the studies not taking a thiazide diuretic. however, there is evidence that when hypokalemia(low blood potassium) in these people is corrected, blood glucose control improves. the takeaway message is that thiazide diureticsare considered a good first choice for treatment of high blood pressure because they are effective,cause few side effects, and are inexpensive,

but certain individuals may develop diabetesor experience difficulty controlling blood glucose while on a thiazide diuretic. potassium levels should be monitored and correctedwhen necessary. beta-blockersbeta-blockers are the other major class of blood-pressure-lowering drugs that have beenimplicated in causing diabetes or worsening diabetes control. the several large studies that have lookedat the risk of diabetes associated with beta-blockers include the nurses health studies i and iiand the ongoing aric (atherosclerosis risk in communities) study.

in these two studies, the risk of developingdiabetes in people originally without it who took beta-blockers was approximately 20% to28% greater than in those who did not take beta-blockers. this may seem counterintuitive since peoplewith diabetes are often warned that beta-blockers can cause problems with low blood glucose,not high blood glucose. beta-blockers cause these two problems indistinct ways. first, they may harm a person’s abilityto recognize and respond to low blood glucose, mainly by keeping the heart rate slow, whichcan dampen symptoms of hypoglycemia. they may also inhibit the release of glucosefrom the liver.

but beta-blockers also block the release ofinsulin by interacting with nerve signals to the pancreas and can thus lower insulinlevels even when blood glucose is high. there is some evidence that not all beta-blockersaffect insulin secretion. beta-blockers work by interacting with proteinsin the body called beta receptors. there are several distinct types of beta receptorsin the body. beta-1 receptors are predominantly in theheart, while beta-2 receptors are in the heart as well as the arteries, muscles, liver, andpancreatic beta cells. this means that beta-1–selective drugs areless likely to interfere with the secretion and regulation of insulin.

several studies have shown that a combinationof beta-blockers and thiazide diuretics, as expected, also produces an increase in therisk of developing diabetes, by approximately 20%. the national institute for health and clinicalexcellence in the united kingdom, an advisory group that develops national health policy,has placed a limited caution against the combined use of beta-blockers and thiazide diureticsfor people at high risk for diabetes (because of family history, impaired glucose tolerance,or obesity, for example). while the risk of diabetes-related complicationsfor the population as a whole is relatively low, these drugs may be a source of preventablediabetes or of diminished blood glucose control

in individual cases. of note, ace inhibitors and calcium channelblockers have not been strongly linked to diabetes. niacin nicotinic acid, or niacin, is a b vitamincommonly used to lower blood lipids (fats). it can reduce low-density lipoprotein (ldl,or “bad”) cholesterol and triglycerides and also raise high-density lipoprotein (hdl,or “good”) cholesterol. the combination of elevated ldl cholesteroland triglycerides with low hdl cholesterol is a common lipid profile in people with diabetes.

while the drug has many side effects, oneof the more important ones is worsening blood glucose control. however, data on the effect of niacin on bloodglucose control is not as plentiful as data on diuretics and beta-blockers. one well-controlled study of 148 people withdiabetes evaluated the effects of several different doses of niacin on both blood lipidsand blood glucose control. the goal of the study was to evaluate thecommon medical practice of avoiding prescribing niacin to people with diabetes. fasting blood glucose levels as well as glycosylatedhemoglobin (hba1c, another measure of blood

glucose control) levels were evaluated overa 16-week period. while the doses of 1,000 mg and 1,500 mg ofniacin were effective for blood lipids, the higher dose resulted in an average increasein hba1c of 0.3 percentage points, and four people on niacin left the study due to itsworsening of blood glucose control. the conclusions of the study were that niacincan be safely used in people who have diabetes, but that once again, in select individualsit can have an adverse effect on blood glucose control. in another study, niacin was tested in combinationwith simvastatin, another blood-lipid-lowering drug, in 160 people who had low hdl cholesterolbut normal ldl cholesterol.

the investigators looked mainly at the progressionof lesions in coronary arteries, but they also evaluated blood glucose and insulin levels. participants who received these two drugsdemonstrated a significant reduction in coronary artery lesions and heart attacks. they also, however, had elevated insulin levelsbut not elevated blood glucose. this suggests that niacin may cause insulinresistance, a condition in which the body does not use insulin efficiently. in a review article that examined trials ofniacin for both cardiovascular benefits and risks pertaining to diabetes care, it wasclear that niacin has significant and positive

benefits for cardiovascular health (namely,reduced heart attacks) but that small increases in blood glucose and insulin levels occurthat may require adjustments to diabetes therapy. antipsychotic drugs antipsychotic drugs are used to treat severepsychiatric conditions such as schizophrenia. while schizophrenia is not a common diseaseamong people who have diabetes, among people with schizophrenia, there is a 15% prevalenceof diabetes and a risk of developing it two to three times that of the general population. some of this risk may be due to family history,poor diet, and physical inactivity. but recent evidence suggests that some drugsused to treat schizophrenia may increase the

risk of developing diabetes. a consensus statement from the american diabetesassociation and the american psychiatric association recognizes that antipsychotic drugs, and inparticular olanzapine and clozapine, can elevate blood glucose, cause weight gain, and increaseblood lipids. these drugs also raise the risk for diabeticketoacidosis, an uncommon but extremely serious complication of diabetes. several hypotheses have been proposed regardinghow these drugs may cause diabetes, from simply inducing weight gain to impairing insulinsecretion; but so far, no strong evidence explains why these drugs have this effect.

striking a balance there is a longer list of drugs associatedwith diabetes, but the evidence for each of these is not very strong, or the medicineis only used rarely. for the more commonly used drugs that areknown to worsen diabetes control, it is important to note that there remains a balance betweenintended benefits and unwanted side effects. glucocorticoids can stop an inflammatory processlike asthma, thiazide diuretics have been shown to be very successful at reducing highblood pressure and its complications, beta-blockers do protect against heart attacks, niacin doesreduce coronary artery disease, and antipsychotic medicines can make the difference betweenhallucinating and perceiving reality.

if you suspect that your blood glucose controlmay be adversely affected by a medicine you’re taking, speak with your health-care providerbefore making any changes. there may be an overall benefit to remainingon a drug that slightly increases blood glucose in some cases, or there may be alternativesthat can be substituted. unfortunately, no medicine is without itsdrawbacks, but by knowing what these drawbacks are, you can participate in an informed discussionwith your health-care provider about the specific risks and benefits of a drug in your uniquesituation. don’t forget to get my new ebook. like this video and subscribe to our channelso we can continue to bring you informative

videos like this one in the future. thanks for watching!

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