Amlodipine besylate is surely one of the drugs most prescribed to hypertensive patients as well as those experiencing chest pain or angina. It comes under calcium channel blockers that create an end to the pressure in the blood vessels to increase the flow in the bloodstream. This medicine may be used with other prescribed medications to control high blood pressure. Therefore, the drug controls angina by preventing enough oxygen-rich blood from reaching the heart muscle, relieving symptoms of chest pain. However, a common concern is whether Can Amlodipine Besylate cause Diabetes? Despite its effectiveness in lowering blood pressure, some studies suggest a potential link to increased blood sugar levels, which could lead to a diagnosis of diabetes in certain cases.
How does it work?
Amlodipine is a medication that helps relax and widen your blood vessels, making it easier for your heart to pump blood.
- Blocks Calcium: Amlodipine prevents calcium from entering the cells of your blood vessels and heart. Calcium normally makes muscles contract, so by blocking it, your blood vessels stay relaxed.
- Lowers Blood Pressure: When your blood vessels relax and widen, it reduces the pressure in your arteries. This helps lower your blood pressure.
- Eases Heart’s Job: With lower blood pressure, your heart doesn’t have to work as hard to pump blood, which helps prevent heart problems like chest pain (angina).
Side effects of Amlodipine
It may cause side effects. Consult your doctor if you have any of the symptoms given below.
- nausea
- stomach pain
- dizziness or lightheadedness
- drowsiness
- excessive tiredness
- flushing
- swelling of the hands, feet, ankles, or lower legs
- muscle stiffness or tremors
Can Amlodipine Besylate Cause Diabetes Or High Blood Sugar?
Though this is seldom the case, there have been recorded instances wherein it brought about hyperglycemia in patients. It occurs when the body fails to produce or manufacture enough insulin or when the insulin is not that effective in the body. It leads to the development of type 2 diabetes if it is not treated well.
Although the link is not as well established as with thiazide diuretics and beta-blockers, whose association with hyperglycemia is well documented, it has been reported in the literature to affect insulin release by blocking Ca2+ activity in the pancreas and to increase blood sugar levels over time.
Studies on Amlodipine and Diabetes Risk
Amlodipine, a calcium channel blocker commonly prescribed for hypertension, has been studied for its effects on the risk of developing type 2 diabetes. Research findings are mixed, with some studies indicating a potential increase in diabetes risk, while others suggest a neutral or even protective effect.
Increased Risk of Diabetes:
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) compared amlodipine to chlorthalidone and found that patients on amlodipine had a 34% lower risk of developing new-onset diabetes compared to those on chlorthalidone.
Neutral or Protective Effects:
A systematic review published in Diabetes Care examined various antihypertensive medications and their association with type 2 diabetes incidence. The study concluded that calcium channel blockers, including amlodipine, did not significantly affect the risk of developing diabetes.
Another study in Cardiovascular Diabetology assessed the impact of azelnidipine, a long-acting calcium channel blocker, on glucose tolerance and insulin resistance. The results suggested that azelnidipine improved glucose tolerance and insulin sensitivity, indicating potential benefits for patients at risk of diabetes.
Case Report: Amlodipine-Induced Hyperglycemia
Amlodipine, a calcium channel blocker commonly prescribed for hypertension, has been associated with hyperglycemia in certain cases. While this side effect is rare, it is important to recognize and manage it appropriately.
Case Reports and Observations:
- Amlodipine-Induced Hyperglycemia: A 57-year-old woman developed significant hyperglycemia after initiating amlodipine therapy for essential hypertension. Approximately three weeks post-initiation, she experienced symptoms such as polyuria, polydipsia, and vision changes. Laboratory tests revealed a fasting blood glucose of 305 mg/dL and an HbA1c of 9.1%. After discontinuing amlodipine, her blood glucose levels normalized, and her HbA1c decreased to 5% within three months.
- Amlodipine Overdose and Hyperglycemia: A 74-year-old man intentionally ingested 400 mg of amlodipine, resulting in hypotension and hyperglycemia. His laboratory data confirmed elevated blood glucose levels. Management included high-dose insulin therapy, which effectively addressed both hypotension and hyperglycemia.
Mechanisms and Considerations:
The exact mechanism by which amlodipine induces hyperglycemia is not fully understood. It is hypothesized that calcium channel blockade may impair insulin release from pancreatic beta cells, leading to elevated blood glucose levels. However, such occurrences are uncommon, and amlodipine is generally considered to have a low risk of causing hyperglycemia compared to other antihypertensive agents.
Clinical Implications:
Healthcare providers should be vigilant for signs of hyperglycemia in patients starting amlodipine therapy, especially those with predisposing factors for diabetes. Regular monitoring of blood glucose levels may be advisable in such cases. If hyperglycemia is detected, discontinuing amlodipine and initiating appropriate management strategies, including lifestyle modifications and pharmacological interventions, should be considered.
Implications for Patients and Healthcare Providers
For Patients
Although this risk is very low, the actual cause of Diabetes by the drug should be clear to the patient as well as to other healthcare providers. Patients taking Amlodipine besylate should regularly check their blood sugar levels, especially if they experience symptoms like thirst, increased urination, or blurred and double vision.
Healthcare providers
Healthcare providers should be aware of the risks of hyperglycemia when prescribing Amlodipine, especially among patients with more significant risk profiles for Diabetes. These would be individuals who have family histories of Diabetes, are obese or carry other risk factors for metabolic disorders. In such cases, healthcare providers should initiate blood sugar monitoring immediately to detect early signs of hyperglycemia.
Role of Continuous Glucose Monitoring (CGM)
- Enhanced Blood Glucose Monitoring: For patients on Amlodipine, particularly those with diabetes or at risk, a Continuous Glucose Monitoring Device (CGM) can be crucial in tracking glucose levels. CGM systems provide continuous, 24/7 glucose readings, helping both patients and healthcare providers detect any significant changes in blood sugar early, especially in response to Amlodipine-induced hyperglycemia.
- Better Decision-Making: With continuous data, healthcare providers can make more informed decisions about adjusting medications, lifestyle, and diet. For example, CGM data can help fine-tune insulin dosages or antihypertensive treatment plans based on how the patient’s glucose levels fluctuate with Amlodipine use.
- Empowering Patients: Patients using CGM have the ability to monitor their glucose levels in real-time, empowering them to take proactive steps, such as adjusting their diet or activity levels, to manage hyperglycemia. This can be particularly beneficial for those who may not regularly check their blood sugar or are at risk of unrecognized hyperglycemia.
- Early Detection of Trends: CGM can help detect trends in glucose spikes that might be linked to Amlodipine, allowing for quicker interventions to prevent long-term complications, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state (HHS).
Recommended CGMs for Amlodipine-Induced Hyperglycemia
The Dexcom G7, Freestyle Libre 3 sensor, and Medtronic Guardian Connect are top CGMs recommended for managing Amlodipine-induced hyperglycemia due to their accuracy, real-time glucose tracking, and ease of use.
- Dexcom G7: 10-15 minute lag, highly accurate, integrates with smartphones. Sensor lifespan: 10 days. FDA-approved.
- Freestyle Libre 3: Continuous, real-time monitoring with minimal calibration. Sensor lifespan: 14-15 days. FDA-approved.
Conclusion:
Like other drugs, Amlodipine Besylate also has the potential for risks and side effects. However, hyperglycemia from using Amlodipine is reported to occur very rarely. The abovementioned case report raises the question, “Can Amlodipine Besylate Cause Diabetes?” It suggests that patients prescribed this drug should regularly undergo examinations to ensure their blood sugar levels remain within a healthy range. Suppose you are on Amlodipine and suspect you may be experiencing symptoms of high sugar levels in your blood, such as excessive thirst or urination. In that case, it is essential to visit your healthcare provider. Early detection and treatment of hyperglycemia can prevent the onset of Diabetes, while the management plan will also remain safe and effective for you. Like every drug, there is an appropriate weighing of risks versus benefits for long-term health care.
Reference
https://link.springer.com/article/10.1007/s40278-024-58927-8
https://wileymicrositebuilder.com/practicaldiabetes/wp-content/uploads/sites/29/2018/10/CR-DeGeeter_P-lsw.pdf
https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-10-79
https://pharmatimes.com/news/amlodipine_cuts_new_diabetes_risk_by_34_995927/
