Which medication Jessica is receiving is most likely to contribute to increased blood glucose?

• A. Azathioprine (Imuran)
• B. Diphenoxylate (Lomotil)
• C. Prednisone (Deltasone)
• D. Sulfasalazine (Azulfidine)

Answer: (C)

Glucocorticoids like prednisone commonly raise blood glucose. They stimulate the liver to produce more glucose (gluconeogenesis) and reduce the body's sensitivity to insulin, so glucose stays in the bloodstream rather than entering cells. This metabolic effect is a well-known side effect of prednisone, especially with higher doses or longer courses, and is often monitored in patients receiving steroids for inflammatory conditions like IBD.

Azathioprine, an immunosuppressant, primarily affects immune cells and can cause liver or bone marrow side effects but doesn’t typically cause hyperglycemia. Diphenoxylate is an anti-diarrheal that slows gut movement and doesn’t impact glucose metabolism. Sulfasalazine is an anti-inflammatory drug with GI and hematologic considerations but not a common driver of elevated blood glucose. Therefore, prednisone is the medication most likely to contribute to increased blood glucose.