The Link Between Antibiotics And Diabetes

Back in 1928, Alexander Fleming discovered penicillin, the first true antibiotic. Soon after, several other antibiotics came onto the scene, namely ampicillin, amoxicillin, and benzylpencillin.

These days we have more “modern” antibiotics such as:

• Cephalosporins: You might know it better as cephalexin. It’s used to treat UTIs, ear infections, respiratory infections and bacterial meningitis.

• Macrolides: These include erythromycin, clarithromycin, and azithromycin and are primarily used to treat lung infections. They can also be substituted in people who are allergic to penicillin.

• Tetracyclines: Tetracycline and doxycycline are typically used to treat acne and rosacea.

• Fluoroquinolones: These antibiotics, which include ciprofloxacin (cipro) and levofloxacin, are used to treat UTIs and respiratory infections.

• Sulfonamides: such as trimethoprim and co-trimoxazole are used to treat eye and ear infections, UTIs, bronchitis, and bacterial meningitis.

• Aminoglycosides: These are the big guns and are usually brought out to treat serious and difficult-to-treat infections, such as sepsis and are often given intravenously.

At some point in our lives, most of us will have a reason to take a course or two of one or more of these antibiotics. And in many instances, antibiotics can be absolute life savers.

But there is a growing body of research that suggests a strong link between antibiotics and increased risks associated with diabetes.

Antibiotics and Unstable Blood Sugars

First, I’m not suggesting that you should never take antibiotics. On the contrary, those at risk for diabetes often develop infections including UTIs, skin infections and can be more prone to colds and the flu. It is, however, important to be careful with the type of antibiotics you take and be cautious about taking them.

Should an infection occur it’s important to have an honest discussion with your healthcare provider to understand the type of infection you have, how it should be treated, and the best type of antibiotic to take.

For instance, the fluoroquinolones are one class of antibiotic that may be more likely to cause swings in your blood sugar levels. So, should you develop a UTI, as an example, and your doctor prescribes ciprofloxacin (Cipro), you could run the risk of having blood sugar that’s too high or too low during your course of treatment.

Gatifloxacin is another antibiotic that has been shown to cause severe hypo and hyperglycemia, so much so that in 2006 the FDA issued a warning against using this antibiotic in those with diabetes. The medicine has since been removed from the U.S. market.

There are many more antibiotics still on the market that can be a real and dangerous problem for people with diabetes. In 2014, a study published in JAMA: Internal Medicine looked at older people with diabetes who were taking a class of diabetes medication called sulfonylureas (e.g., glipizide, glyburide). The researchers found certain antibiotics, and a large swath of them including ciprofloxacin, clarithromycin, levofloxacin, metronidazole, or sulfametoxazole-trimethoprim, were linked to higher rates of hypoglycemia. Worse still, of those hypoglycemic events, 40% were associated with hospitalization and 60% with emergency department visits. ¹

Another study published in the Journal of Clinical Endocrinology & Metabolism in 2015 looked at data pertaining to 170,000 Danish citizens who had Type 2 diabetes and compared their antibiotic use with citizens who did not have diabetes (the control group).

The results?

Those in the control group who filled between two to four prescriptions for antibiotics had a 23% higher risk of diabetes, and those who filled five or more prescriptions had a whopping 53% higher risk (twice as likely) to develop the disease. ²

It’s important to understand the mechanism underneath these findings. The study does not suggest that by taking these antibiotics your body will automatically develop diabetes. What happens is that certain antibiotics can disrupt the microbiome in the gut (antibiotics wipe out good bacteria along with the bad). This in turn changes a person’s insulin sensitivity and glucose tolerance, thus predisposing them to Type 2 diabetes.

So what can you do to risk of developing problems?

Avoid Infection

Your first line of defense against possible antibiotic complications is to avoid infections as much as possible. Wash hands regularly, handle food safely, and avoid unnecessary dangers (not wearing shoes while walking in the grass or on the sidewalk).

Know What Kind of Infection You Have

Too many people make an appointment with their doctor to request antibiotics after the first sniffle or sign of a sore throat. And far too many doctors are obliging patients who have viral infections, not bacterial. This is contributing to antibiotic resistance and putting those with diabetes at unnecessary risk. Viral infections such as colds, stomach flu, and bronchitis will not respond to antibiotics.

Be Your Own Advocate

When an antibiotic is necessary, be sure to ask your doctor how the one they are prescribing you will affect your blood sugars, as well as how it will interact with any diabetes medication you may be taking.

Take as Directed

Follow directions and never take any leftover antibiotics for an infection you may get later on. And never take antibiotics that may have been prescribed for a friend or family member. You have no idea how they may impact your blood sugar.

Check Your Blood Sugars Often

While on any antibiotic, check your blood sugar levels more frequently to avoid hypo and hyperglycemic episodes.

Final Thoughts

Antibiotics definitely have an important place in medicine and do a lot of good for many people. That said, it’s important to recognize their potential dangers. If you are at risk for diabetes, talk with your doctor before taking any antibiotics.

Resources:

[1] Trisha M. Parekh, DO, Mukaila Raji, MD, MS, Yu-Li Lin, MS, Alai Tan, MD, PhD, Yong-Fang Kuo, PhD, and James S. Goodwin, MD. Hypoglycemia After Antimicrobial Drug Prescription for Older Patients Using Sulfonylureas. JAMA Intern Med. 2014 Oct; 174(10): 1605–1612

[2] Mikkelsen KH, Knop FK, Frost M, Hallas J, Pottegård A. Use of Antibiotics and Risk of Type 2 Diabetes: A Population-Based Case-Control Study. J Clin Endocrinol Metab. 2015 Oct;100(10):3633-40