Welcome back to our weekly advice column, Ask D'Mine, where you get all sorts of tips about navigating life with diabetes from host Wil Dubois, a former D-clinical educator and diabetes author who's longtime type 1 himself. Today, Wil's tackling a co-morbidity topic and how other medications may have an impact on diabetes. 

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Lisa, type 1 from New Mexico, asks:Does albuterol have an effect on blood sugar? It seems to me lately that when I use my inhaler, my sugar goes up. But it’s not a steroid, is it? 

Wil@Ask D’Mine answers:Your first question isn’t as straightforward as it seems, so let me tackle the second one first. No, pure unadulterated albuterol isn’t a steroid. It’s beta-2-agonist, a class of drugs that act on the beta 2 adrenergic receptor, part of the muscle control system. Basically, albuterol works like aroma therapy candles. Well, not really, but its job is to coax the beta 2 adrenergic receptor to relax the smooth muscles that can, in some cases, start squeezing the airway shut—like during an asthma attack.

But do beta-2-agonist inhalers raise blood sugar? 

The prescribing info sheet for the albuterol inhalers, which was created at the time of FDA approval, does not list elevated blood sugar as a side effect, nor did elevated BGs show up in post marketing studies—although albuterol can cause virtually every other side effect under the sun. Still, despite that lengthy list of dire side effects, albuterol is generally regarded as a kitten. In fact, Vets apparently use it to treat coughs in cats. Who knew?

Case closed, right?

No. Because my go-to drug side effect website includes albuterol on its list of Drugs That May Cause Hyperglycemia. WTF…?

Well, in addition to coming in aerosol form, albuterol also comes in pills, and in a liquid that can be delivered intravenously—and that’s where things get interesting. Apparently, it’s well known that IV albuterol can cause blood sugar to spike, but that side effect wasn’t seen in clinical studies of the inhaled version, so one group of researchers decided to look into this further. They created a small double-blind in which PWDs took either a huff of albuterol or placebo first thing in the morning. What happened? The data showed very little difference in most participants, but two subjects had a 50-point spike on albuterol!

I guess, if nothing else, they proved that your diabetes may vary.

Still, this doesn’t surprise me. Dose makes the poison, right? If injected albuterol tends to raise blood sugar in nearly everyone, it’s only logical that some people will be sensitive enough to it to have the same experience with an inhaled version. Supporting this, I found some albuterol-using PWDs over on Tu Diabetes reporting that their sugars go up with exercise, the opposite of what is generally seen. I don’t even want to speculate today about how exercise might super-size the albuterol effect, because there’s one other fly in the ointment that might be confusing things. Well, I guess albuterol only comes in aerosol, pills, and liquids… not ointments…. But I digress.

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Remember at the start that I said that pure unadulterated albuterol isn’t a steroid? Well, guess what? Pure and unadulterated albuterol is less common than you’d expect, because albuterol is FDA approved to be paired with an inhaled steroid.

Ut-oh. 

Yeah, this is because albuterol only relaxes the smooth muscles, which is about 50% of the problem during an asthma attack. The other half of the problem is inflammation also squeezing the airway shut, and albuterol doesn’t do diddly squat for inflammation. To knock down inflammation you need a steroid, so many of the inhalers on the market have both albuterol and a steroid in them.

Examples of these hybrid inhalers are Advair and Symbicort. Meanwhile, pure unadulterated albuterol is found under brand names like ProAir and Proventil, among others. So… is your albuterol really just albuterol, or is it a hybrid with a steroid as the secret sauce? We all know what steroids do to blood sugar, right?

Of course, as if that weren’t enough, we need to consider why you are taking albuterol. Most commonly it’s Rx’d for asthma, a disease that can trigger attacks of difficult breathing. Thank God I don’t have asthma, but I know some folks that do, and their descriptions of asthma attacks are nothing short of terrifying.

Guess what else happens to your body when you are terrified.

Right.

Adrenaline. The cavewoman flight or fight response kicks in and your adrenal glands dump a ton of sugar into your bloodstream to fuel your muscles for Super Girl action. Of course, the only muscles you’re using in our modern world are the ones involved in getting the inhaler out of your purse, so there’s a lot of unused sugar in play. You didn’t fight or flee.

So there’s much to consider here, and there are at least three ways your inhaler could be causing your blood sugar to spike. First, is your albuterol just albuterol? Or do you have a hybrid with a sugar-raising steroid in the mix? If so, I’d wager the albuterol did not raise your blood sugar, but that it’s partner in crime did. Second, is it the medicine that raises your sugar, or is it the attack that has you reaching for your inhaler? That seems highly likely to me. Even if you’re only having a mildly annoying attack, surely the Spector of a worse outcome must be in your mind. And lastly, hey, maybe you’re one of those untypical people whose sugar gets bumped by inhaled albuterol.

So there are lots of ways albuterol, its environment, or its friends can raise your blood sugar. With that much smoke, there must be fire, regardless of the exact cause. Of course, if the smoke were anything but metaphorical, you’d be reaching for your inhaler… with a high blood sugar right around the corner.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.