Hypoglycemia with sulfasalazine and hydroxychloroquine

[girldoc]

I've had several hypoglycemic episodes over the past few months, characterized by extreme weakness and tremors, and with the last two episodes, severe sweating as well. Friends and family thought I might be prediabetic. I didn't think that my sulfasalazine played any role, but when I googled sulfasalazine and hypoglycemia, lo and behold, there were numerous entries for that. Most of those entries dealt with patients being treated for diabetes and having renal impairment, but two studies looked for hypoglycemia in non-diabetic patients and found that sulfasalazine and hydroxychloroquine can cause hypoglycemia whereas other RA drugs do not.

In my case, I believe, I've had those episodes because my appetite has markedly decreased and I've frequently delayed eating when it was inconvenient, so the combination of lack of food and sulfasalazine made me hypoglycemic. I've taken sulfasalazine in the past but then my appetite was normal and I ate normally and didn't have a problem with blood sugar. I've quit the sulfasalazine for other reasons but may be going on hydroxychloroquine, so I know now that's it's essential to eat something about every three hours.

[13Lab]

I was on Sulphasalazine for about 7 years and had frequent mild hypoglycaemia.

My hbac-1 was always in low twenties.

I stopped sulphasalazine in June to transition to MTX and my hbac-1 shot up to 43! No more hypoglycaemic spells.

It appears that sulphasalazine was helping to lower my blood sugar.

[Fruitandnutcase]

Have you actually checked your blood glucose when you feel like that because when I feel weak an shaky like you describe and test my blood sugar it is always ok.

I’m also like you in that I need to eat regularly. I’ve been taking hydroxychloroquine for about ten years but I was like that before I started it so I’d say the hydroxy has nothing to do with it.

What do your doctors have to say about it?

[girldoc in reply to Fruitandnutcase]

I would have loved to be have been able to check my blood glucose at those moments but could not. There was so much to discuss with my rheumatologist when I saw her two weeks ago, that I never mentioned the hypoglycemic attacks. I had no idea that sulfasalazine had anything to do with it until a few days ago. Now that I'm off the sulfasalazine and taking greater care in when I eat, I don't know if it is worthwhile getting my HbA1c tested.

[Fruitandnutcase in reply to girldoc]

You can buy a Code free blood sugar monitor quite reasonably from Amazon and check your own.

GPs don’t give them out unless you are taking diabetes meds - or they didn’t when I had the problem - I bought mine when I was given a course of steroids for inflammatory arthritis some years ago and developed steroid induced T2 diabetes. I was given three months to get it under control by diet but as I already ate what I thought was a healthy diet I couldn’t figure out if I was doing the right things.

So I found a very good book about how to reverse your T2 diabetes and I bought my own blood sugar monitor and did what the book told me to do that was really interesting, I discovered that things that I used to think were really healthy like jacket potatoes really spiked my blood. It was really interesting to discover the things that spiked my blood sugar - for me it was carbs - to be honest it included an awful lot of the foods on the government recommended ‘healthy plate’

That was when I discovered that what I thought was being hypoglycaemic wasn’t that at all.

You might find your doctor is quite happy to test your HbA1c. That covers your levels over the previous three months or so. Good luck with it all.