Hypoglycemia—aka low blood sugar—can kill you. The most common cause is medications taken by people with diabetes.
DRUGS THAT RARELY, IF EVER, CAUSE HYPOGLYCEMIA
Diabetics not being treated with pills or insulin rarely need to worry about hypoglycemia. That’s usually true also for prediabetics. Yes, some type 2 diabetics control their condition with diet and exercise alone, without drugs.
Similarly, diabetics treated only with diet, metformin, colesevalam, sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor), and/or an alpha-glucosidase inhibitor (acarbose, miglitol) should not have much, if any, trouble with hypoglycemia. The DPP4-inhibitors (sitagliptan and saxagliptin) do not seem to cause low glucose levels, whether used alone or combined with metformin or a thiazoladinedione. Thiazolidinediones by themselves cause hypoglycemia in only 1 to 3% of users, but might cause a higher percentage in people on a reduced calorie diet. Bromocriptine may slightly increase the risk of hypoglycemia. GLP-1 analogues rarely cause hypoglycemia, but they can.
DRUGS THAT CAUSE HYPOGLYCEMIA
Regardless of diet, diabetics are at risk for hypoglycemia if they use any of the following drug classes. Also listed are a few of the individual drugs in some classes:
- sulfonylureas: glipizide, glyburide, glimiperide, chlorpropamide, acetohexamide, tolbutamide
- meglitinides: repaglinide, nateglinide
- pramlintide plus insulin
- possibly GLP-1 analogues
- GLP-1 analogues (exanatide, liragultide, albiglutide, dulaglutide) when used with insulin, sufonylureas, or meglitinides
- possibly thiazolidinediones: pioglitazone, rosiglitazone
- possibly bromocriptine
BECOME THE EXPERT ON YOUR OWN DRUGS
If you take drugs for diabetes, you need to be your own pharmaceutical expert. Don’t depend solely on your physician or pharmacist. Your doctor has to be familiar with 150–200 drugs, and the pharmacist, even more. You only need to master two or three, I hope. Here are important things to know about your drugs:
- interactions with other drugs or supplements you take, whether prescription or over-the-counter
- how to monitor for drug toxicity (e.g., periodic blood tests)
- potential adverse effects
- is the money-saving generic just as good as the brand-name drug
- what’s the maximum dose and how often can the dose be adjusted
- if you take a brand-name drug, what’s the generic name