Antibiotics and Diabetes: Do the Two Mix?

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Chances are, at some point in your life you’ve taken a course of antibiotics. Maybe you took penicillin as a child for strep throat. Or perhaps you’ve been given azithromycin (brand names Zithromax, Z-Pak, and others) for a sinus or upper respiratory infection. No doubt, antibiotics are lifesavers — in most instances.

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You might have wondered how antibiotics affect your diabetes control, if at all. And even if you’ve never given it a thought, there are a few pointers to keep in mind when it comes to using antibiotics.

Antibiotics 101

Antibiotics are medicines that fight infections caused by bacteria. They kill bacteria or keep them from reproducing. Antibiotics are powerful drugs that, when used properly, can save lives. (Unfortunately, antibiotics are often used improperly, and that’s creating a serious set of problems, which I’ll get to in a moment.)

Alexander Fleming discovered penicillin in 1928 (a good piece of trivia to remember), and now there are several antibiotics that are related to penicillin, including ampicillin, amoxicillin, and benzylpencillin. These drugs are used to treat a variety of infections, such as chest infections, urinary tract infections (UTIs), and skin infections. There are also more “modern” antibiotics available, such as:

• Cephalosporins: used to treat UTIs, ear and skin infections, respiratory infections, bacterial meningitis, and sepsis. These include cephalexin (Keflex).

• Macrolides: used to treat lung and chest infections, and are also used in case of a penicillin allergy or penicillin resistance. These include erythromycin (E-Mycin), clarithromycin (Biaxin), and azithromycin (Zitromax, Z-pak, and others).

• Tetracyclines: often used to treat acne and rosacea. These include tetracycline (Sumycin, Panmycin) and doxycycline (Vibramycin).

• Fluoroquinolones: broad-spectrum antibiotics used for respiratory infections and UTIs. These include ciprofloxacin (Cipro), levofloxacin (Levaquin), and ofloxacin (Floxin).

• Sulfonamides: used to treat UTIs, bronchitis, eye and ear infections, pneumonia, and bacterial meningitis. These include co-trimoxazole (Bactrim) and trimethoprim (Proloprim, Trimpex).

• Aminoglycosides: used to treat serious and difficult-to-treat infections, such as sepsis. They’re often given intravenously, but they’re also available orally or in drop form. These include gentamicin (Garamycin) and tobramycin (Tobrex).

Antibiotic resistance

There’s no doubt that antibiotics are invaluable. However, thanks to antibiotics being overused and used improperly, we’re now facing a serious and scary problem called antibiotic resistance. The Centers for Disease Control and Prevention (CDC) estimates that “at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a result of these infections.”

What exactly is antibiotic resistance? In a nutshell, it means that microbes, such as bacteria, literally “resist” the effect of drugs. The antibiotics don’t kill them or slow their growth. All types of microbes, including bacteria, viruses, fungi, and parasites, have the ability to become resistant to drugs. Resistant bacteria are called “superbugs.” Unfortunately, because antibiotics are among the most commonly prescribed medicines, and because up to 50 percent of the time they are prescribed inappropriately (for example, treating a viral infection with an antibiotic) or not taken in the correct dose or for the correct amount of time, antibiotic resistance has become a huge problem. To make matters worse, resistant strains of bacteria can spread from person to person, or from non-human sources (such as animals) in the environment. To learn more about antibiotic resistance and what you can do, visit the CDC’s website.

Antibiotics and diabetes

People who have diabetes can take antibiotics. This is important to know, as having diabetes raises the risk of a number of types of infections, including UTIs, skin infections, and infections in the hands and feet. If you get an infection, it’s equally as important to understand a) the type of infection you have, b) how it should be treated, and c) the best type of treatment. A frank dialogue with your health-care provider is in order.

Once class of antibiotics, the fluoroquinolones, may be more likely to cause serious swings in your blood sugars. So, if you have a UTI, for example, and your doctor prescribes ciprofloxacin (Cipro), you run the risk of having high and/or low blood sugars. Gatifloxacin (Tequin), in particular, has been linked with severe hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar); as a result, the Food and Drug Administration (FDA) issued a warning in 2006 against using this antibiotic in people who have diabetes, and the medicine has since been removed from the U.S. market.

A study published in JAMA: Internal Medicine in 2014 looked at older adults with diabetes who were taking a class of diabetes pills called sulfonylureas (e.g., glipizide, glyburide). The authors looked at patients who were given certain types of antibiotics (ciprofloxacin, clarithromycin, levofloxacin, metronidazole, or sulfametoxazole-trimethoprim). These drugs were linked with higher rates of hypoglycemia (low blood sugar), and of those hypoglycemic events, almost 40 percent were associated with hospitalization and 60 percent with emergency department visits.

If you’re at risk for developing Type 2 diabetes, you might be interested in a study published in The Journal of Clinical Endocrinology & Metabolism in 2015. The researchers looked at information from 170,000 Danish citizens who had Type 2 diabetes and compared their antibiotic use with citizens who did not have diabetes (the control group). Those in the control group who filled two to four prescriptions for antibiotics had a 23 percent higher risk of diabetes; those who filled five or more prescriptions had a 53 percent higher risk. Now, this study does not mean that taking antibiotics caused diabetes, but the authors suggest that antibiotics can disrupt the microbiome in the gut, which, in turn, can change insulin sensitivity and glucose tolerance, thus increasing the likelihood of Type 2 diabetes.

Bottom line

Should you take antibiotics if you have diabetes? It depends! The following eight tips may be helpful:

1. Aim for prevention.

Avoiding infection is your first course of action. Washing your hands often, doing your best to keep your blood sugars within target range, eating well, handling food safely, staying active, and getting enough rest are important steps to take to stay healthy.

2. Know your infection.

If you are ill, don’t be too quick to beg your doctor for an antibiotic. Many infections are caused by a virus, and antibiotics won’t work. In fact, they can do more harm than good, as they can raise the risk of antibiotic resistance. Viral infections that will not respond to antibiotics include the common cold, the flu, bronchitis, stomach flu, and some ear and sinus infections.

3. Take as directed.

If you need an antibiotic, take it as prescribed. That means taking the full dose for the full amount of time, even if you feel better or your symptoms are resolved. Also, don’t take any leftover antibiotics for an infection that you may get later on, and never take antibiotics that have been prescribed for someone else.

4. Be choosy.

Ask your doctor about the best type of antibiotic for your particular infection, and don’t forget to ask how that antibiotic can affect your blood sugars, as well as any diabetes medicines (actually, any medicines) that you’re taking.

5. Check your blood sugars often.

Illness tends to raise blood sugars, and antibiotics may do the same. They can also cause low blood sugars. To be safe, check your blood sugars at least four times a day, or as often as recommended by your doctor or diabetes educator. In addition, follow your sick-day plan for insulin adjustments (if applicable), food choices, and when to seek medical attention.

6. Be aware of side effects.

All medicines can cause side effects. The most common antibiotic side effects are nausea, vomiting, cramps, diarrhea, fever, and light sensitivity. You may also have an allergy to an antibiotic. Some allergic reactions can be extremely serious and even life-threatening: trouble breathing, hives, Stevens-Johnson syndrome (a condition that affects the skin and mucous membranes), irregular heartbeat, tendon rupture, seizures, and coughing up blood or bleeding from the rectum. Seek medical attention right away if any of these occur.

7. Get your probiotic fix.

Antibiotics kill off the bad bacteria in your system. Unfortunately, they can do a number on the good bacteria that you have in your gut, and you may suffer the consequences (abdominal pain, diarrhea, yeast infections in women). Some experts believe that taking probiotics, or good bacteria, may counteract these effects. There are a number of types of probiotics on the market, and you should always check with your doctor or dietitian before taking them. However, you CAN focus on eating foods rich in probiotics. These include yogurt (with live cultures), kefir, sauerkraut, kimchi, miso, and tempeh.

8. Ask questions.

If you have concerns or questions about an antibiotic that’s prescribed for you, let your doctor or pharmacist know. Learn more about antibiotics here.

Want to learn more about diabetes and antibiotics? Read “Antibiotics Linked to Lows in People Taking Certain Diabetes Drugs,” “Nerve Damage and Flouroquinolone Antibiotics,” “Certain Antibiotics Linked to Blood Glucose Swings.” And learn more about probiotics in “Probiotics and Prebiotics: Parts of Healthy Diet.”

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