A numbers of drugs and chemicals may cause hyperglycemia by interfering with insulin secretion or peripheral action. These agents can result in overt diabetes in a person with insulin resistance.
Features:
(1) hyperglycemia following onset of therapy with drug or exposure to chemical
(2) diabetes may develop if the exposed patient has insulin resistance and/or features of the metabolic syndrome
(3) reversal on discontinuation of exposure (if reversible agent)
Drugs with reversible effect include:
(1) nicotinic acid
(2) glucocorticoids or anabolic steroids in high doses
(3) thyroid hormone
(4) alpha-adrenergic agonists or centrally-acting alpha blockers
(5) beta-adrenergic agonists or beta-blockers
(6) thiazides
(7) diazoxide (related to the thiazides)
(8) dilantin/phenytoin
(9) interferon-alpha
(10) atypical antipsychotics
(11) cyclosporine or tacrolimus
(12) didanosine
(13) protease inhibitors
(14) L-asparaginase
(15) terbutaline
(16) ritodrine
(17) calcium-channel blockers
(18) minoxidil
(19) tesamorelin
Drugs and chemicals with potentially irreversible effect (due to destruction of pancreatic beta cells):
(1) pentamidine (also may cause severe hypoglycemia for weeks after therapy, perhaps due to release of insulin from injured beta cells)
(2) Vacor
(3) streptozotocin (an alkylating agent)
(4) alloxan
where:
• Vacor (Rohm & Haas) is the brand name for pyriminil, which is used as a rodenticide.
