Beta-blockers And Diabetes: The Bad Guys Come Good.
Beta-blockers and diabetes: the bad guys come good. Type 2 diabetes is becoming very common and is closely linked to physical inactivity and obesity. It is associated with clustering of coronary risk factors and 60-80% of cases have hypertension. The first therapeutic action is appropriate adjustment of life style. Anti-hypertensive therapies such as diuretics, ACE inhibitors and calcium antagonists have been effective in reducing cardiovascular events in type 2 diabetes, though calcium antagonists may be less effective than older therapies and ACE-inhibitors in reducing the risk of heart attacks and heart failure (but possibly more effective in stroke reduction). Beta-blockers (BBs) have a poor image as a potential therapy due to apparent adverse effects on surrogate end-points such as insulin-resistance. However large, controlled trials have shown BBs to be highly effective in reducing the risk of cardiovascular events and death in post myocardial infarction patients with diabetes. The UKPDS study in type 2 diabetics with hypertension showed first-line beta-blockade to be at least as effective as ACE-inhibition in preventing all primary macrovascular and microvascular end-points. The active ingredient appears to be beta-1 blockade, acting not only to lower blood pressure but also to prevent sudden death and cardiovascular damage stemming from chronic beta-1 stimulation associated with raised noradrenaline activity. By contrast, in the LIFE study atenolol was less effective than the angiotensin receptor antagonist losartan in reducing cardiovascular events and all-cause mortality in mainly elderly hypertensives with diabetes. Thus the best beta-blocker results in reducing hard cardiovascular end-points occur in hypertension studies (including the UKPDS study) involvin Continue reading >>
Beta Blockers And Diabetes: Mechanism And Risks
Beta Blockers and Diabetes: Mechanism and Risks Watch short & fun videos Start Your Free Trial Today Alyssa is an active RN and teaches Nursing and Leadership university courses. She also has a Doctorate in Nursing Practice and a Master's in Business Administration. Log in or sign up to add this lesson to a Custom Course. Custom Courses are courses that you create from Study.com lessons. Use them just like other courses to track progress, access quizzes and exams, and share content. Organize and share selected lessons with your class. Make planning easier by creating your own custom course. Create a new course from any lesson page or your dashboard. Click "Add to" located below the video player and follow the prompts to name your course and save your lesson. Click on the "Custom Courses" tab, then click "Create course". Next, go to any lesson page and begin adding lessons. Edit your Custom Course directly from your dashboard. Name your Custom Course and add an optional description or learning objective. Create chapters to group lesson within your course. Remove and reorder chapters and lessons at any time. Share your Custom Course or assign lessons and chapters. Share or assign lessons and chapters by clicking the "Teacher" tab on the lesson or chapter page you want to assign. Students' quiz scores and video views will be trackable in your "Teacher" tab. You can share your Custom Course by copying and pasting the course URL. Only Study.com members will be able to access the entire course. Beta-blockers are common medications used to control high blood pressure, but can block dangerous signs of low blood sugar in people with diabetes. Read this lesson to learn more about how diabetes is affected by this class of medication. Diabetes occurs when the body creates little t Continue reading >>
Beta Blockers And Diabetes Mellitus - General Practice Notebook
Betal 2 Receptors have an important role in hepatic glucose production in humans and may contribute to hypoglycemia associated with unselective beta-blockade (1) e.g. use of propranolol rather than the use of beta-1 selective blockers e.g. atenolol, metoprolol. beta -2-adrenergic antagonism has a role in the inhibition of hepatic gluconeogenesis therefore was believed that selective beta-1 blockers would not lead to hypoglycaemia - however "...in patients with abnormal energy requirements or metabolism, administration of beta 1-selective-adrenergic antagonists may be associated with hypoglycaemia..."(2) Beta blockers in diabetes and insulin resistance: studies, such as the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE) (3) with atenolol, the Carvedilol or Metoprolol European Trial (COMET) (4) with metoprolol have shown a 22% to 28% increase of new-onset diabetes with traditional beta beta-blockers that can increase insulin resistance (and hence hyperglycaemia) (5) side effects of beta -blockers in the patient with diabetes include increased insulin resistance with worsening glycemic control increased frequency of hypoglycemia and its lack of recognition can also be a problem in the insulin-deficient patient but is a minimal problem with the patient with type 2 diabetes (5) there is evidence that some beta-blockers may have 'insulin-sensitising properties' (5) carvedilol, a nonselective beta-blocker had vasodilating and insulin-sensitizing properties, and is the ideal beta-blocker for the patient with diabetes (5) carvedilol is a third generation beta-blocker in comparison with atenolol which is a second generation beta blocker 1) William-Olsson T, Fellenius E, Bjorntorp P, Smith U. Differences in metabolic responses to beta-adrenergic stimula Continue reading >>
Beta-adrenergic Blockade And Diabetes Mellitus. A Review.
beta-adrenergic blockade and diabetes mellitus. A review. The use of beta-blockers in diabetes mellitus has largely been restricted becauseof the reported adverse effects. Clinical investigations aimed at elucidating thepossible reactions associated with the use of beta-blockers have disclosed noevidence of masking or signs or insulin-induced hypoglycaemia or potentiation of the insulin effect. Prolonged hypoglycaemia may develop, however, as a result of physical effort. There is no proof that during insulin-induced hypoglycaemia the concentrations of counter-regulatory hormones are depressed, but that ofglycerol, a gluconeogenic precursor, is slightly diminished. Intensification ofthe hypertensive reaction during hypoglycaemia is less likely to occur duringtreatment with beta-selective blockers. In insulin-dependent diabetics receiving beta 1-blockers there is no evidence of any change - either deterioration orimprovement - in metabolic control. In one small controlled trial there was nosign of impairment of the peripheral arterial circulation over a short period of administration of a non-selective beta-blocker. In general, for patientssuffering from insulin-dependent diabetes, cardioselective agents are preferable.Since cardioselectivity is a dose-dependent property, reasonable caution shouldalso be observed when using this type of drug in diabetes. Diabetes Mellitus, Type 1/physiopathology* Continue reading >>
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Comments On Beta Blockers Mask Hypoglycemia
Propranolol can be detrimental to diabetic patients in two ways. First, by blocking beta2 receptors in muscle and liver, propranolol can suppress glycogenolysis, thereby eliminating an important mechanism for correcting hypoglycemia (which can occur when insulin dosage is excessive). Second, by blocking beta1 receptors, propranolol can suppress tachycardia, which normally serves as an early warning signal that blood glucose levels are falling too low. (When glucose drops below a safe level, the sympathetic nervous system is activated, causing an increase in heart rate.) By masking tachycardia, propranolol can delay awareness of hypoglycemia, thereby compromising the patient's ability to correct the problem in a timely fashion. Diabetic patients who are taking propranolol should be warned that tachycardia may no longer be a reliable indicator of hypoglycemia. In addition, they should be taught to recognize alternative signs (sweating, hunger, fatigue, poor concentration) that blood glucose is falling perilously low. Because of its ability to suppress glycogenolysis and mask tachycardia, propranolol must be used with caution by diabetic patients." (Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. 19.4.1.5.2). pg 169 Continue reading >>
Uses For Beta Blockers
Doctors prescribe beta blockers to prevent, treat or improve symptoms in a variety of conditions, such as: High blood pressure Irregular heart rhythm (arrhythmia) Heart failure Chest pain (angina) Heart attacks Migraine Certain types of tremors Beta blockers aren't usually prescribed for blood pressure until other medications, such as diuretics, haven't worked effectively. Your doctor may prescribe beta blockers as one of several medications to lower your blood pressure, including angiotensin-converting enzyme (ACE) inhibitors, diuretics or calcium channel blockers. Beta blockers may not work as effectively for black and older people, especially when taken without other blood pressure medications. Side effects and cautions Side effects may occur in people taking beta blockers. However, many people who take beta blockers won't have any side effects. Common side effects of beta blockers include: Fatigue Cold hands or feet Weight gain Less common side effects include: Shortness of breath Trouble sleeping Depression Beta blockers generally aren't used in people with asthma because of concerns that the medication may trigger severe asthma attacks. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. It's important to monitor your blood sugar regularly. Beta blockers can also affect your cholesterol and triglyceride levels, causing a slight increase in triglycerides and a modest decrease in high-density lipoprotein, the "good" cholesterol. These changes often are temporary. You shouldn't abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems. Continue reading >>
Beta Blockers
Beta blockers, also called beta-adrenergic blocking agents, treat a variety of conditions, such as high blood pressure and migraines. Find out more about this class of medication. Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow. Examples of beta blockers Some beta blockers mainly affect your heart, while others affect both your heart and your blood vessels. Which one is best for you depends on your health and the condition being treated. Examples of oral beta blockers include: Acebutolol (Sectral) Atenolol (Tenormin) Bisoprolol (Zebeta) Metoprolol (Lopressor, Toprol-XL) Nadolol (Corgard) Nebivolol (Bystolic) Propranolol (Inderal LA, InnoPran XL) Doctors prescribe beta blockers to prevent, treat or improve symptoms in a variety of conditions, such as: High blood pressure Irregular heart rhythm (arrhythmia) Heart failure Chest pain (angina) Heart attacks Migraine Certain types of tremors Beta blockers aren't usually prescribed for blood pressure until other medications, such as diuretics, haven't worked effectively. Your doctor may prescribe beta blockers as one of several medications to lower your blood pressure, including angiotensin-converting enzyme (ACE) inhibitors, diuretics or calcium channel blockers. Beta blockers may not work as effectively for black and older people, especially when taken without other blood pressure medications. Side effects and cautions Side effects may occur in people taking beta blockers. However, many peop Continue reading >>
[true And Presumed Contraindications Of Beta Blockers. Peripheral Vascular Disease, Diabetes Mellitus, Chronic Bronchopneumopathy].
[True and presumed contraindications of beta blockers. Peripheral vascular disease, diabetes mellitus, chronic bronchopneumopathy]. U.O.A. di Cardiologia, A.S.O. San Luigi, Orbassano. [email protected] Ital Heart J Suppl. 2000 Aug;1(8):1031-7. Traditional contraindications to beta-blockers are peripheral vascular diseases, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma. Recent data seem to show that rigorous application of these rules are not completely justified and indicate that many patients would be inappropriately excluded from the beneficial effects of this therapy. Appraisal of clear guidelines for a safe use of beta-blockers is thus mandatory for the clinician. A brief review of the effects of beta-adrenergic receptor blockade is offered. The therapy is aimed at blocking beta 1-receptors. On the other hand, the block of beta 2-receptors causes the well known side effects, i.e. vasoconstriction, delayed response to hypoglycemia in diabetic patients, bronchoconstriction. From the first compound, propranolol, with uniform action on beta 1 and beta 2-receptors, further generation of beta-blockers were subsequently developed: beta 1-selective, with intrinsic sympathomimetic activity, and with associated vasodilating "ancillary" property. Some favorable reduction in collateral effects has thus been obtained with new compounds, without reaching complete safety. Examination of exclusion criteria applied in clinical trials offers no useful indications because of their imprecise definition. Examination of the literature and a more accurate understanding of the diseases, traditionally considered contraindications, may help setting up a uniform and clear path: peripheral vascular disease: beta-blockers should be avoided only in those patients with Continue reading >>
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Beta Blocker Use In Subjects With Type 2 Diabetes Mellitus And Systolic Heart Failure Does Not Worsen Glycaemic Control
Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control Wai et al; licensee BioMed Central Ltd.2012 The prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known but despite this, in patients with diabetes they are underutilized. The aim of this study was to assess the effect of beta-blockers (BB) on glycaemic control in patients with Type 2 Diabetes (T2DM) and systolic heart failure (SHF) stratified to beta-1 selective (Bisoprolol) vs. nonselective BB (Carvedilol). This observational, cohort study was conducted in patients with T2DM and SHF attending an Australian tertiary teaching hospital's heart failure services. The primary endpoint was glycaemic control measured by glycosylated haemoglobin (HbA1c) at initiation and top dose of BB. Secondary endpoints included microalbuminuria, changes in lipid profile and estimated glomerular filtration rate (eGFR). 125 patients were assessed. Both groups were well matched for gender, NYHA class and use of guideline validated heart failure and diabetic medications. The mean treatment duration was 1.9 1.1 years with carvedilol and 1.4 1.0 years with bisoprolol (p = ns). The carvedilol group achieved a reduction in HbA1c (7.8 0.21% to 7.3 0.17%, p = 0.02) whereas the bisoprolol group showed no change in HbA1c (7.0 0.20% to 6.9 0.23%, p = 0.92). There was no significant difference in the change in HbA1c from baseline to peak BB dose in the carvedilol group compared to the bisoprolol group. There was a similar deterioration in eGFR, but no significant changes in lipid profile or microalbuminuria in both groups (p = ns). BB use did not worsen glycaemic control, lipid profile or albuminuria status in subjects with SHF and T2DM. Carve Continue reading >>
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Beta-blockers For The Treatment Of Hypertension In Patients With Diabetes: Exploring The Contraindication Myth.
Beta-blockers for the treatment of hypertension in patients with diabetes: exploring the contraindication myth. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA. [email protected] To review the evidence supporting the "contraindications" (hypoglycemic unawareness, insulin resistance, and dyslipidemia) usually given as the reasons for not using beta blockers for treating hypertension in patients with diabetes mellitus. A research synthesis based on MEDLINE (January 1966 through January 1999), hand searches of pertinent references and textbooks, and consultation with experts. There is little evidence to support the assertion that beta blockers should be routinely contraindicated in diabetes. Beta blockers have few clinically important effects on hypoglycemic awareness and recovery, insulin resistance and hyperglycemia, or lipid profiles. Moreover, when diabetics have been treated with beta blockers for hypertension or for the secondary prevention of myocardial infarction, they benefit as much, if not more, than nondiabetic patients. There may be circumstances (e.g., hypertensive patients with coronary disease) under which beta blockers are the drugs of first choice for diabetic patients. Recommendations to use agents other than beta blockers for the treatment of hypertension in diabetes are based on these agents' effectiveness against surrogate endpoints, and not their proven benefit in preventing important clinical endpoints. Except for patients with brittle glycemic control, manifest hypoglycemic unawareness, renal parenchymal disease, or documented intolerance, beta blockers should no longer be considered routinely contraindicated in the presence of diabetes. Continue reading >>
Beta Blocker - An Overview | Sciencedirect Topics
J.S.A.G. Schouten, in Side Effects of Drugs Annual , 2009 Beta-adrenoceptor antagonists are associated with an increased risk of depression. The data from electronic medical records of a health maintenance organization have been used to analyze the relation between antiglaucoma prescriptions and antidepressant prescriptions (9C). Among patients with glaucoma there was no difference in prescriptions for antidepressants between those who were using beta-adrenoceptor antagonists (12.7% of 5846) and those who were not (12.2% of 751). Drugs in eye-drops can cause allergic periorbital contact dermatitis. Data on 112430 patch-tested patients during 19932004 from a network of departments of dermatology have been analyzed to assess whether patients had positive patch-tests for beta-adrenoceptor antagonists (10C). Of 332 patients who used betaxolol, carteolol, levobunolol, metipranolol, or timolol eye-drops, 43 (13%) tested positive. Allergic contact dermatitis was strongly suspected in 59% of the patients before patch-testing. Based on the prescription rate of beta-adrenoceptor antagonist and the extrapolated number of cases who tested positive to the beta-adrenoceptor antagonist that they were using, it was estimated that the incidence is one per million defined daily doses. Barbara Resnick, in Primary Care Geriatrics (Fifth Edition) , 2007 Beta-blocker use has been recommended to prevent first events of nonfatal myocardial infarction in patients with high blood pressure since 1989.90 Beta-blocker use has also been noted to be effective as secondary prevention of a myocardial infarction and can lead to a 19% to 48% decrease in mortality and up to a 28% decrease in reinfarction rates.91 Older adults may need to be started on a lower dose than recommended in the younger adult po Continue reading >>
Controlling Hypertension In Patients With Diabetes
Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Nearly one in four adults in the United States has hypertension, and more than 10 million adults have diabetes.1 Moreover, hypertension is twice as common in persons with diabetes as it is in others.2 Obesity may be a common link between the two disorders, but other factors such as insulin resistance3 and autonomic dysfunction4 may also be involved. Excess weight with truncal obesity, hypertension, impaired glucose tolerance, insulin resistance, and dyslipidemia are among the components of the metabolic syndrome, which has been associated with an increased risk of coronary heart disease.5 In general, only 25 percent of patients with hypertension have adequate control of their blood pressure.6 Blood pressure goals are lower, and thus more difficult to achieve, in patients who also have diabetes. Elevated blood pressure is known to contribute to diabetic microvascular and macrovascular complications (Table 1).4,7,8 Fortunately, reductions in blood pressure can decrease the risk of these complications.8 TABLE 1 Microvascular complications Renal d Continue reading >>
Diabetic Hypoglycemia
Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an estimated 55,819 cases (8.0% of total admissions) involved insulin, and severe hypoglycemia is likely the single most common event.[1] In general, hypoglycemia occurs when a treatment to lower the elevated blood glucose of diabetes inaccurately matches the body's physiological need, and therefore causes the glucose to fall to a below-normal level. Definition[edit] A commonly used "number" to define the lower limit of normal glucose is 70 mg/dl (3.9 mmol/l), though in someone with diabetes, hypoglycemic symptoms can sometimes occur at higher glucose levels, or may fail to occur at lower. Some textbooks for nursing and pre-hospital care use the range 80 mg/dl to 120 mg/dl (4.4 mmol/l to 6.7 mmol/l). This variability is further compounded by the imprecision of glucose meter measurements at low levels, or the ability of glucose levels to change rapidly. Signs and symptoms[edit] Diabetic hypoglycemia can be mild, recognized easily by the patient, and reversed with a small amount of carbohydrates eaten or drunk, or it may be severe enough to cause unconsciousness requiring intravenous dextrose or an injection of glucagon. Severe hypoglycemic unconsciousness is one form of diabetic coma. A common medical definition of severe hypoglycemia is "hypoglycemia severe enough that the person needs assistance in dealing with it". A co-morbidity is the issue of hypoglycemia unawareness. Recent research using machine learning methods have proved to Continue reading >>
How Diabetics Taking Beta Blockers Still Sweat With Hypoglycemia
There are 23.6 million children and adults (7.8 percent of the population) in the United States alone that have diabetes mellitus (DM).1 Unfortunately, 65 percent of the deaths in diabetic patients are due to heart disease and stroke. In fact, adults with DM are 2 to 4 times more likely to have heart disease and/or a stroke than adults without diabetes.2 The elevated cardiovascular risk in diabetics is partially due to the high prevalence (about 73 percent of all diabetics) of hypertension (defined as > 130/80 mm Hg) for which treatment with beta blockers is indicated. 2 Thus, the use of beta blocking agents is relatively common in those living with DM. Beta blockers, such as atenolol (Tenormin), metoprolol (Toprol; Toprol XL), carvedilol (Coreg; Coreg CR) and many others, are known to be antagonists of the noradrenergic response that results from the release of catecholamines by the sympathetic nervous system.4-6 The sympathetic branch of the autonomic system is activated primarily during an acute stress response ("fight or flight") and releases the predominant neurotransmitter, norepinephrine, from post-ganglionic sympathetic nerve fibers.7,8 In addition, the sympathetic nervous system also causes the adrenal glands to release both epinephrine (80%) and norepinephrine (20%). Norepinephrine and epinephrine may then activate the adrenergic receptors of various organs, such as beta-1 receptors in the heart which results in tachycardia (increase pulse).7,8 This acute stress response can be activated by hypoglycemia (low blood sugar) which may occur episodically in diabetic patients. Hypoglycemia generally occurs in diabetics when the blood glucose level falls below 70 mg/dL and is most often observed in patients receiving insulin or those being treated with tight glucose Continue reading >>
Beta-blockers For The Treatment Of Hypertension In Patients With Diabetes: Exploring The Contraindication Myth
, Volume 13, Issue5 , pp 435439 | Cite as Beta-blockers for the Treatment of Hypertension in Patients with Diabetes: Exploring the Contraindication Myth Purpose: To review the evidence supporting the contraindications (hypoglycemic unawareness, insulin resistance, and dyslipidemia) usually given as the reasons by physicians for not using beta blockers for treating hypertension in patients with diabetes mellitus. Methods: A research synthesis based on MEDLINE (January 1966 through January 1999), hand searches of pertinent references and textbooks, and consultation with experts. Results: There is little evidence to support the assertion that beta blockers should be routinely contraindicated in diabetes. Beta blockers have few clinically important effects on hypoglycemic awareness and recovery, insulin resistance and hyperglycemia, or lipid profiles. Moreover, when diabetics have been treated with beta blockers for hypertension or for the secondary prevention of myocardial infarction, they benefit as much, if not more, than nondiabetic patients. There may be many circumstances (e.g., hypertensive patients with coronary disease) under which beta blockers are the drugs of first choice for diabetic patients. Recommendations to use agents other than beta blockers (or low dose thiazide diuretics) for the treatment of hypertension in diabetes are based on these agents' effectiveness against surrogate endpoints, and not their proven benefit in preventing important clinical endpoints. Conclusions: Except for patients with brittle glycemic control, manifest hypoglycemic unawareness, renal parenchymal disease, or documented intolerance, beta blockers should no longer be considered routinely contraindicated in the presence of diabetes. hypertensiondiabetes mellitustreatmentbeta bloc Continue reading >>
