Can Suboxone Cause Low Blood Sugar?

No, not usually. Low blood sugar is not usually a side effect of buprenorphine/naloxone (Suboxone). If you have diabetes and an opioid use disorder (OUD), you can use Suboxone safely.

Search the internet, and you may find many people claiming that their Suboxone doses lowered their blood sugar.[1] What's going on?

If you have diabetes and feel symptoms of low blood sugar while on Suboxone, you may incorrectly attribute these symptoms to Suboxone itself instead of the Diabetes.

Conversely, if you are starting Suboxone and have symptoms of dizziness, nausea, etc, (which can also be symptoms of low blood sugar), you may attribute these symptoms to low blood sugar instead of Suboxone.

If you do have any symptoms that concern you, check your blood sugar at the time you have the symptoms and take immediate steps to raise your blood sugar if it is low, like eating a small snack or drinking some juice or taking a glucose tablet.

The U.S. Food and Drug Administration lists known drug side effects. The Suboxone information does not list low blood sugar.[2] In the pre-release testing pharmacists completed, the medication did not lower blood sugar readings.

If you don't have diabetes and these feelings are persistent or get worse, talk with your doctor.

Full Opioids & Blood Sugar

If a patient is taking opioids like heroin or fentanyl on a daily basis and is subsequently not eating or taking care of their nutrition, they may experience low blood sugar, particularly if they also have predisposing conditions like diabetes [3] Even in this case, however, the low blood sugar is usually due to malnutrition and undereating, and not to the medication or drugs themselves. Suboxone doesn't seem to cause this effect. 

Is Suboxone Safe for People With Diabetes?

Yes. If you are taking insulin or getting another form of diabetes treatment, let your doctor know. However, many diabetic patients can also take buprenorphine/naloxone (Suboxone) without issue.

In one study, people with diabetes and opioid use disorder had better glucose control while taking Suboxone.[4] Researchers aren't exactly sure why this happens, but it certainly confirms that if anything, treatment for OUD might improve glycemic control, not worsen it. 

What to Do if You Experience Low Blood Sugar 

If you have diabetes or a history of low blood sugar, it might be helpful to check your blood sugar at the time you feel these symptoms to confirm that the sugar is actually low and not due to another cause.

The Centers for Disease Control and Prevention recommends the 15-15 rule for blood sugar readings between 55 and 69 mg/dL: [5]

• Eat. Take in a food worth 15 grams of carbs. That means something like 4 ounces of juice, a tablespoon of honey, or a few gumdrops. 
• Wait. Rest for 15 minutes before testing again. 
• Repeat. Follow the steps again if your numbers don't rise to good levels.

If your blood sugar is severely low, get emergency treatment.

If you have any concerns about your blood sugar/glycemic control while taking Suboxone, reach out to your doctor. They can work with you to control your blood pressure and to continue to treat your opioid use disorder safely.

Sources

1. Suboxone and Hypoglycemia: A Phase IV Clinical Study of FDA Data. eHealth Me. https://www.ehealthme.com/ds/suboxone/hypoglycemia/. June 2022. Accessed July 2022.
2. Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf. August 2010. Accessed July 2022.
3. Methadone Induced Hypoglycemia, Improved on Dose Adjustment. Journal of Clinical and Translational Endocrinology: Case Reports. https://www.sciencedirect.com/science/article/pii/S2214624520300162. December 2020. Accessed July 2022.
4. Opioid Use Disorder and Type 2 Diabetes Mellitus. Canadian Family Physician. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507246/. July 2017. Accessed July 2022. 
5. How to Treat Low Blood Sugar (Hypoglycemia). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/low-blood-sugar-treatment.html. March 2021. Accessed July 2022.