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Why Beta Blockers Are Not Used In Diabetes?

Drugs That Can Worsen Diabetes Control

Drugs That Can Worsen Diabetes Control

One of the main goals of any diabetes control regimen is keeping blood glucose levels in the near-normal range. The cornerstones of most plans to achieve that goal include following a healthy diet, getting regular exercise, and taking insulin or other medicines as necessary. However, it’s not uncommon for people with diabetes to have other medical conditions that also require taking medicines, and sometimes these drugs can interfere with efforts to control blood glucose. A few medicines, including some commonly prescribed to treat high blood pressure and heart disease, have even been implicated as the cause of some cases of diabetes. This article lists some of the medicines that can worsen blood glucose control, the reasons they have that effect, the usual magnitude of the blood glucose changes, as well as the pros and cons of using these drugs in people who have diabetes. Where the problems occur To understand how various medicines can worsen blood glucose control, it helps to understand how insulin, the hormone responsible for lowering blood glucose, works in the body. Insulin is released from the beta cells of the pancreas in response to rising levels of glucose in the bloodstream, rising levels of a hormone called GLP-1 (which is released from the intestines in response to glucose), and signals from the nerve connections to the pancreas. The secretion of insulin occurs in two phases: a rapid first phase and a delayed second phase. Both of these phases are dependent on levels of potassium and calcium in the pancreas. Insulin acts on three major organs: the liver, the muscles, and fat tissue. In the liver, insulin enhances the uptake of glucose and prevents the liver from forming new glucose, which it normally does to maintain fasting glucose levels. In muscle and f Continue reading >>

Beta Blockers And Diabetes: Mechanism And Risks

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 >>

Statins And Beta-blockers Increase Risk Of Developing Diabetes, New Study Confirms

Statins And Beta-blockers Increase Risk Of Developing Diabetes, New Study Confirms

November 12, 2012 – There was also a borderline effect towards developing new-onset diabetes among patients who started taking beta-blockers but it was not significant after adjusting for key clinical factors. Beta-blockers, statins, and diuretics are routinely used to lower the risk of death or serious events such as heart attacks in patients with cardiovascular disease. Despite the benefits, data suggests that these medications, particularly statins, can also increase fasting glucose levels and raise a patient’s risk of developing diabetes. A new study was the first to use serial glucose measurements to determine the effect of diuretics, beta-blockers, and statins on glucose levels. DCRI fellow Lan Shen, MD, (pictured) presented the findings at the 2012 American Heart Association Scientific Sessions. More than 9,500 patients with impaired glucose tolerance and other cardiovascular risk factors were enrolled in a sub-study of the NAVIGATOR trial. This sub-study is based on a population that was naïve to treatment with beta-blockers, diuretics, and statins at baseline enrollment. Patients had glucose measurements taken every six months for the first three years then annually thereafter. Average follow-up time for the trial was 5 years for new diabetes onset and 6.5 years for vital statistics. While enrolled in the study, approximately 17 percent of patients who were beta-blocker naïve at baseline began taking beta-blockers, 22 percent who were diuretic naïve at baseline started taking diuretics, and 24 percent who were statin naïve at baseline started taking statins. Patients who began taking diuretics and statins were significantly more likely to develop new-onset diabetes than patients who did not begin taking those medications. There was also a borderline eff Continue reading >>

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

, 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 >>

Antihypertensive Treatment With Beta-blockers And The Spectrum Of Glycaemic Control

Antihypertensive Treatment With Beta-blockers And The Spectrum Of Glycaemic Control

Antihypertensive treatment with beta-blockers and the spectrum of glycaemic control From the Hypertension/Clinical Research Center, Departments of Preventive and Internal Medicine, Rush University Medical Center, Chicago, USA Address correspondence to Dr P.A. Sarafidis, Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, 1700 West Van Buren, Suite 470, Chicago, IL 60612, USA. email: [email protected] Search for other works by this author on: From the Hypertension/Clinical Research Center, Departments of Preventive and Internal Medicine, Rush University Medical Center, Chicago, USA Search for other works by this author on: QJM: An International Journal of Medicine, Volume 99, Issue 7, 1 July 2006, Pages 431436, P.A. Sarafidis, G.L. Bakris; Antihypertensive treatment with beta-blockers and the spectrum of glycaemic control, QJM: An International Journal of Medicine, Volume 99, Issue 7, 1 July 2006, Pages 431436, Hypertension and type 2 diabetes mellitus (DM) are major cardiovascular risk factors, and often cluster in the same individual in the context of the metabolic syndrome. Management of hypertension in the diabetic patient is extremely important, and agents from all major antihypertensive classes are effective towards this goal. Conventional -blockers are associated with detrimental effects on insulin sensitivity, glycaemic control, and the incidence of type 2 DM and thus are less often used in hypertensive patients with DM. In contrast, the newer vasodilating -blockers appear to be free of adverse effects on the above metabolic parameters, and could be a valuable tool for hypertension treatment in patients with DM or the metabolic syndrome. This review summarizes the evidence on the effects of antihypertensi Continue reading >>

Controlling Hypertension In Patients With Diabetes

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 >>

Newer Beta-blocker Coreg Safer For Diabetics

Newer Beta-blocker Coreg Safer For Diabetics

The beta-blocker blood pressure medicine Coreg proved significantly better in keeping blood sugar levels from rising in diabetics than metaprolol, another widely used member of the beta-blocker family. The study involved 1,235 high-risk patients with type 2 diabetes and hypertension — two of the biggest risk factors for heart disease. It measured long-term blood sugar levels of those taking Glaxo’s Coreg, or carvedilol, against those taking the generic drug metoprolol for at least five months. Most of those in the study were also taking cholesterol medication. While both drugs were similarly effective in lowering blood pressure to the desired goal of less than 130 over 80, Coreg demonstrated superiority in keeping blood sugar levels from worsening. “Side effects are the big Achilles heel of beta-blockers,” said Dr. George Bakris, director of the hypertension clinical research unit at Rush University Medical Center in Chicago and the lead investigator of the study. Beta-blockers generally do a good job of lowering blood pressure and decreasing some cardiovascular risks, Bakris said. But they tend to raise blood sugar, slow the heart rate and can increase cholesterol problems such as triglycerides. Slow heart rate, for example, was much higher in the metoprolol group, Bakris said. At least 18 million Americans suffer from high blood pressure, type 2 diabetes and high cholesterol, Bakris said, making traditional beta-blockers that raise blood sugar problematic for this patient population. Coreg has been on the market since 1997 as a treatment for hypertension and heart failure with sales of $577 million for the first nine months of this year. Researchers believes the antioxidant activity of Coreg is what separates it from other beta blockers. This study should help Continue reading >>

Diabetes And Beta-blockers: What You Need To Know

Diabetes And Beta-blockers: What You Need To Know

People with diabetes tend to develop heart disease or stroke at an earlier age than the general population. One reason for this is that high glucose levels increase your risk of high blood pressure (hypertension). According to the American Diabetes Association, almost one in three American adults has high blood pressure. Two out of three people with diabetes have high blood pressure. Type 2 Diabetes and Hypertension High blood pressure doesn’t necessarily cause symptoms. You may feel just fine, but don’t let that fool you. Your heart is working harder than it should. It’s a serious condition, especially for people with diabetes. High blood pressure puts a lot of extra stress on your body. Over time, it can cause hardening of the arteries. It can also damage your brain, kidneys, eyes, and other organs. Treating High Blood Pressure If you have high blood pressure, your doctor may want to try other methods of treating it before turning to beta-blockers. These may include lifestyle changes and taking better control of blood glucose levels. The decision to use medication, including beta-blockers, will depend on your personal medical history. A 2015 study published in the Journal of the American Medical Association recommends drug therapy with a blood pressure reading of above 140 systolic and above 90 diastolic (140/90). For people with diabetes, lowering high blood pressure reduces the risk of developing cardiovascular problems, kidney disease, and neuropathy. Beta-Blockers Beta-blockers (beta-adrenergic blocking agents) are a class of prescription drug. They are used to treat a variety of conditions such as glaucoma, migraines, and anxiety disorders. They are also used to treat heart failure and high blood pressure. High blood pressure can increase your risk for hear Continue reading >>

Beta-blockers And Diabetes: The Bad Guys Come Good.

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 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

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 >>

Beta Blockers And The Risk Of Cv Events In Type 2 Diabetes

Beta Blockers And The Risk Of Cv Events In Type 2 Diabetes

Home / Conditions / Type 2 Diabetes / Beta Blockers And the Risk of CV Events in Type 2 Diabetes Beta Blockers And the Risk of CV Events in Type 2 Diabetes Beta-blocker use in patients with T2DM and established CV risk factors associated with increased risk of CV events and severe hypoglycemia, according to recent study. Diabetes mellitus management mainly aims at preventing diabetes mellitusrelated complications. Although appropriate glycemic control prevents complications, the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) revealed that intensive therapy can increase all-cause and cardiovascular mortalities. A possible explanation for the results is that glucose-lowering therapy increases the frequency of hypoglycemic episodes, which in turn is associated with increased risks for vascular events and death. Patients with diabetes mellitus with severe hypoglycemia face many critical problems, such as severe hypertension, hypokalemia, and QT prolongation, resulting in cardiovascular diseases, fatal arrhythmia, and death. Recent studies have suggested that -blockers may prevent or decrease the adverse effects after the occurrence of severe hypoglycemia, such as severe hypertension and hypokalemia, and may reduce severe hypoglycemia-associated cardiac arrhythmias and death. A recent study revealed that the cardiovascular event rate in patients with diabetes mellitus on -blockers was significantly lower in the intensive therapy group compared with the standard therapy group. Conversely, all-cause and cardiovascular mortalities in patients not on -blockers were significantly higher in the intensive therapy group. The difference of these results between patients on and those not on -blockers may be mainly because of the protective effects of -blockers after Continue reading >>

Risk Of Cardiovascular Events In Patients With Diabetes Mellitus On Β-blockers

Risk Of Cardiovascular Events In Patients With Diabetes Mellitus On Β-blockers

Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment. The primary outcome was the first occurrence of a cardiovascular event during the study period, which included nonfatal myocardial infarction, unstable angina, nonfatal stroke, and cardiovascular death. The mean follow-up periods (±SD) were 4.6±1.6 years in patients on β-blockers (n=2527) and 4.7±1.6 years in those not on β-blockers (n=2527). The cardiovascular event rate was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.46; 95% confidence interval, 1.24–1.72; P<0.001). In patients with coronary heart disease or heart failure, the cumulative event rate for cardiovascular events was also significantly higher in those on β-blockers than in those not on β-blockers (hazard ratio, 1.27; 95% confidence interval, 1.02–1.60; P=0.03). The incidence of severe hypoglycemia was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.30; 95% confidence interval, 1.03–1.64; P=0.02). In conclusion, the use of β-blockers in patients with diabetes mellitus was associated with an increased risk for cardiovascular events. Introduction Diabetes mellitus management mainly aims at preventing diabetes mell Continue reading >>

New Beta Blocker May Help Diabetic Patients With High Blood Pressure

New Beta Blocker May Help Diabetic Patients With High Blood Pressure

New beta blocker may help diabetic patients with high blood pressure A medication that is commonly used to control high blood pressure does not raise blood sugar levels in diabetics who also have high blood pressure, according to researchers from Rush University Medical Center . The results of the study appear in the November 10 issue of the Journal of the American Medical Association (JAMA) and were presented today at the 2004 American Heart Association Scientific Sessions. Beta blockers have been shown to be effective at lowering high blood pressure but many physicians have been reluctant to prescribe them to patients with diabetes because some beta-blockers have been shown to raise blood sugar levels in diabetics. Especially at risk are the estimated 47 million people with metabolic syndrome, a combination of several risk factors in one person that includes, but is not limited to, high blood pressure, insulin dependence or glucose intolerance, and obesity. "The results of this study suggest that physicians treating diabetic patients may want to consider the role that a newer beta-blocker such as carvedilol could play in managing certain cardiovascular risk factors and components of the metabolic syndrome ," said Dr. George L. Bakris, director, hypertension research center at Rush University Medical Center. "By improving these crucial risk factors, carvedilol could, theoretically, improve overall outcomes in this high-risk patient population." Bakris was the principal investigator of this 1,235-patient study, which is known as GEMINI (Glycemic Effects in Diabetes Mellitus: Carvedilol - Metoprolol Comparison in Hypertensives). Bakris and colleagues compared the effects of carvedilol to metoprolol tartrate in diabetic, hypertensive patients. Patients were randomized to Continue reading >>

Beta-adrenergic Blockade And Diabetes Mellitus. A Review.

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 >>

How Diabetics Taking Beta Blockers Still Sweat With Hypoglycemia

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 >>

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