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Certain pharmaceutical drugs appear to be able to cause diabetes. It is also very clear that drugs can cause weight gain -- insulin is one well-known example.

Type 1 Diabetes


Cancer immunotherapy drugs activate the immune system to attack cancer cells. One problem is that they can also activate the immune system to attack other cells, like the insulin-producing beta cells in the pancreas (these drugs can also cause other autoimmune diseases as well (King et al. 2018)). A number of studies have documented cases of type 1 diabetes following or in conjunction with immunotherapy treatment, although the overall incidence is rare (less than 1% of those who take the drugs) (Gauci et al. 2018; Godwin et al. 2017). A review identified 283 cases of diabetes following treatment with these drugs between 2014-2018 (Wright et al. 2018). 


The New York Times article, The Immune System, Unleashed by Cancer Therapies, Can Attack Organs, discusses how at least 17 people (so far) have developed acute-onset type 1 diabetes following immunotherapy treatment for cancer.
Doctors are wondering if they can predict in advance who might be at risk of developing diabetes after immunotherapy. One lab did a genetic analysis on a patient who took ipilimumab and nivolumab and developed rapid-onset type 1 diabetes (ketoacidosis, positive autoantibodies, no detectable beta cell function). This patient did not have a genetic risk of type 1 diabetes, so genetic testing may not be useful (although larger studies would be helpful here) (Lowe et al. 2016). Further studies are also analyzing if genetic differences may play a role in the response to these drugs (e.g., Matsumura et al. 2018). 

These and other case studies have led to the recognition that autoimmunity is one side-effect of immunotherapy, and efforts are underway to limit it (June et al. 2017).

Chemotherapy and Other Cancer Treatments

A case study describes a man who developed type 1 diabetes while undergoing chemotherapy for cancer, accompanied by abdominal pain and nausea. This is rare but potentially fatal (Adachi et al. 2015).

Interferon-α (INF-α) appears to have caused type 1 diabetes in one cancer patient (Sossau et al. 2017).


Acetaminophen and other analgesic antipyretics, including Non-Steroidal Anti-inflammatory Drugs (NSAIDs), taken in the first 2.5 years of life, have been found to not increase the risk of islet autoimmunity by age 6. However, acetaminophen use in children who had a fever was weakly associated with the development of islet autoimmunity by age 3. Acetaminophen use was much more common in the U.S. than in most European countries (Lundgren et al. 2017). A large, population-based study from Norway found that acetaminophen in the prenatal period or early childhood was not associated with the development of childhood T1D (Tapia et al. 2018). This is something to watch.


A few studies have investigated whether light therapy, i.e., phototherapy, increases the risk of type 1 diabetes. Neonatal phototherapy is used to treat jaundice in newborns. A meta-analysis of 12 published studies found that newborns with jaundice had a slightly increased risk of later developing type 1 diabetes, especially if the jaundice required phototherapy (McNamee et al. 2012). However, a large study from California found no increased risk of type 1 diabetes from neonatal phototherapy (Newman et al. 2016).


A Danish study has found that numerous second-generation (atypical) antipsychotic medications were associated with diabetic ketoacidosis (DKA) and the development of type 1 diabetes (Polcwiartek et al. 2016), as well as DKA and type 2 diabetes (Polcwiartek et al. 2017). One case study describes a 52 year old woman who developed type 1 after taking risperidone for many years. Her blood sugar was 1687 mg/dL when diagnosed! (Hörber et al. 2018).

One of these antipsychotic medications is olanzapine; a case study from Japan describes a 32 year old man who developed acute-onset, autoantibody-positive type 1 diabetes four months after beginning this drug, which was then followed by an extended honeymoon period (Iwaku et al. 2017). This drug is also known for its link to obesity and type 2 diabetes. Exposure to olanzapine in the womb even had metabolic effects on first- and second-generation mice, including glucose intolerance and higher body weight (Courty et al. 2018). 

Anti-Viral Medications

According to a review, interferon therapy to treat hepatitis C increases the risk of developing rapid-onset type 1 diabetes 10-18 fold (Zornitzki et al. 2015). 

A case study also showed a Japanese man developed type 1 while taking highly active antiretroviral therapy (HAART) for HIV. This appears to be partly due to a gene that is present in Japanese people but not Caucasians (Kamei et al. 2015).

Antibiotics and Other Drugs

A case study describes a woman diagnosed with fulminant (fast-acting) type 1 diabetes following drug-induced hypersensitivity syndrome (DIHS). She also had a virus that has been linked to type 1 diabetes (Takeno et al. 2018).

There are a number of studies on antibiotics and type 1 diabetes, discussed on the Diet and the Gut page.

Type 2 Diabetes, Insulin Resistance, and Body Weight

I do not have the time nor inclination to review all the drugs that can cause weight gain, insulin resistance, or even type 2 diabetes here. There are a few lessons we can learn from some of them, however.


Diethylstilbestrol (DES), was a drug given to pregnant women decades ago to prevent miscarriage (it didn't work, but instead led to various health problems in these women's offspring, and now their grandchildren as well). As an estrogen, DES is thought to act similarly to endocrine disrupting chemicals. Fetuses are most vulnerable to its effects, and outcomes may not appear until adulthood. DES is strongly linked to vaginal cancer and adverse reproductive outcomes in offspring. Prenatal exposure to DES may also be linked to other health outcomes, including diabetes, cardiovascular disease, high blood pressure, and high cholesterol (the association with diabetes was not statistically significant, but the risk was higher) (Troisi et al. 2013). Prenatal DES exposure is also linked to slightly increased weight gain in adulthood (Hatch et al. 2015). Prenatal DES exposure is also linked to coronary artery disease and heart attacks, but not strokes (Troisi et al. 2018).

There is some limited evidence linking autoimmunity and DES in humans: women exposed to DES in utero seem to have a higher incidence of autoimmune disease, but only when various autoimmune diseases are grouped together (Ahmed et al. 1999). Yet a more recent study that followed these women over 25 years found that there was not an overall increase in autoimmune diseases in DES exposed daughters, although type 1 diabetes was not included in this study (only four autoimmune diseases were included). However, there was an increased risk of the autoimmune disease rheumatoid arthritis in women under 45, and a lower risk in those over 45 (Strohsnitter et al. 2010).

In animals, when female mice were exposed to a low dose of DES in the first five days of life, they gained more weight by six months of age than mice who were not exposed (Newbold et al. 2009). DES promotes the formation of fat cells in laboratory studies, and increases body weight in mice (Hao et al. 2012). DES also enhances autoantibody production in mice (Yurino et al. 2004).


Rosiglitazone, also known as Avandia, is a drug used to treat type 2 diabetes. It works by binding to PPAR receptors in fat cells and making the cells less insulin resistant. It also causes weight gain (and possibly heart attacks, and thus has been taken off the market in many countries). Activating PPAR receptors causes weight gain because these receptors play an important role in the development of fat cells and fat storage. 

The interesting part is that some "obesogenic" environmental chemicals also bind to PPAR receptors, and therefore may also cause weight gain. Tributyltin, for example, binds the PPARγ receptor, and promotes fat cell development (Heindel et al. 2017). Phthalates also activate PPARγ receptors, and are linked to type 2 diabetes and insulin resistance (e.g., Lind et al. 2012; see more studies on the phthalates page).


Statins-- drugs used for many people with diabetes to reduce the risk of cardiovascular disease-- may have side effects that affect the pancreas and the risk of diabetes. Numerous studies have found that statins are associated with an increased risk of type 2 diabetes (Chen et al. 2013Dormuth et al. 2014Jones et al. 2017; Park et al. 2014; Preiss et al. 2011; Rajpathak et al. 2009; Sattar et al. 2010). Animal studies suggest that statins can decrease insulin secretion. One laboratory study, for example, has found that atorvastatin affected the mitochondria of rat pancreas cells (Sadighara et al. 2017).

Metformin and Pharmaceuticals in Wastewater

The diabetes medication metformin is a common pollutant released from wastewater treatment plants, and can act as an endocrine disruptor to fish living in the water (Briones et al. 2016; Crago et al. 2016Niemuth et al. 2015; Niemuth and Klaper 2018Niemuth and Klaper 2015). Pharmaceuticals released from wastewater treatment plants are becoming more and more of a problem. Wastewater discharged from water treatment plants contains numerous endocrine disrupting compounds, and mice who drank this water gained more fat (Biasiotto et al. 2016).

In people, however, metformin is not only an effective diabetes medication, it can also protect the beta cells and liver cells from the toxic effects of both arsenic and the food fatty acid butyric acid (Ahangarpour et al. 2017). Metformin may also be protective against the effects of air pollution in people with diabetes (Sade et al. 2015).

Yet metformin taken during pregnancy is associated with an increased risk of offspring having a higher weight or being overweight in childhood (Hanem et al. 2018; Rowan et al. 2018).


Children who had obesity by age 3-5 years were more likely to have elevated levels of acetaminophen metabolites at birth (Sorrow et al 2018).

Antibiotics, Surgery, Radiation, and Other Medical Procedures

Studies on antibiotics and diabetes/obesity are discussed on the Diet and the Gut page, as are studies on bariatric surgery. Studies on radiation for cancer are discussed on the Radiation page. Other drugs linked to type 2 diabetes include steroids like prednisone (e.g., after kidney transplantation (Zbiti et al. 2012), which also raise blood glucose levels in people with type 1 diabetes (Bevier et al. 2008). Growth hormones also can increase the risk of diabetes, although the good news is that children given growth hormones for short stature did not have an increased risk of diabetes at age 30 (Poidvin et al. 2017).

And totally unrelated but I think it is interesting, did you know that insulin-producing tumors are a thing? And that they can cause low blood sugar? Even in people with type 1 diabetes! (Gjelberg et al. 2017).


For these and other studies on pharmaceuticals and diabetes/obesity, see the PubMed collection, Pharmaceuticals and diabetes/obesity.