JAC asked
What are issues with atenolol 100 mg and type 1 diabetes?
Answer
According to the package insert atenolol should be used with caution in patients with diabetes. Beta-blockers could mask the tachycardia, or rapid heart beat, that is present with hypoglycemia making it more difficult to identify. The dizziness and sweating associated with hypoglycemia will not be affected by atenolol and can still be used to identify a hypoglycemic dip in blood sugar.
Atenolol. brand name Tenormin, is a synthetic cardio-selective beta-blocker that is commonly used to treat hypertension, relieve chest pains, prevent cardiovascular events after myocardial infarction, and to prevent migraine headaches. Unlike non-selective beta-blockers, atenolol will not delay the recovery time for blood glucose levels to return to normal. At recommended doses atenolol does not promote insulin-induced hypoglycemia.
One pilot study has found that higher levels of atenolol in the blood increases the risk for an rise in fasting blood glucose levels. It is still uncertain as to how beta-blockers increase blood glucose levels, but it is thought that to be because the beta2-adrenergic receptor blockade, more so with non-selective beta-blockers, results in a reduction of insulin secretion in response to glucose.
Hypertension, or high blood pressure, is very common in patients with diabetes. Increased blood pressure in patients with diabetes increases the risk for stroke or other cardiovascular events. The American Diabetes Association (ADA) recommends that patients with diabetes and hypertension to have a target blood pressure less than 140/90 mmHg, unless there is an increased risk for cardiovascular disease. The recommended treatment guidelines include:
- Lifestyle changes and management by promoting weight loss, increased physical activity, and nutrition.
- Regularly check blood pressure at home as well as in the doctor's office.
- Moderate alcohol and sodium intake.
- The first line treatment of hypertension in diabetic patients is an ACE inhibitor, angiotension receptor blocker (ARB), thiazide diuretic, or a calcium channel blocker. If one class is not tolerated you can switch to a different class of medication.
- Initial treatment may require 2 anti-hypertensive medications if the hypertension is severe.
Source: Diabetes Journal
As you can see the current guidelines do not recommend using a beta-blocker as first line treatment of hypertension in patients with diabetes. However, a study from 2002 found that with beta1- selective blockers, like atenolol, have been found to be as effective as ACE inhibitors in preventing cardiovascular events in diabetic patients. This proves that more research is needed regarding the use of selective beta-blockers for the treatment of hypertension in preventing cardiovascular events in diabetic patients.
When considering a new medication it is important to evaluate your medication profile to make sure that there are no drug interactions between the medications that you are taking.
