Insulin Degludec and Atenolol: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atenolol
Insulin Degludec
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Atenolol (a beta blocker for blood pressure or heart) can quietly change how your body handles insulin degludec (Tresiba). The bigger concern is that atenolol can hide some of the usual warning signs of low blood sugar. Normally when your sugar drops, you may feel your heart race, get shaky, dizzy, or sweaty. Atenolol can blunt the fast heartbeat, so a low can sneak up on you. Sweating usually still happens, which is a helpful clue.
The good news: this is very manageable. Your care team may check your sugars a bit more often and fine-tune your insulin dose. Keep taking both as prescribed and let your pharmacist or doctor know how your readings look.
Interaction: Beta blockade plus insulin can alter glycemic control and mask adrenergic hypoglycemia warning signs.
- Direction: Hypo- or hyperglycemia possible; recovery from hypoglycemia may be delayed. Atenolol blunts tachycardia (a key warning sign) while diaphoresis is typically preserved.
- Mechanism: Altered glucose metabolism and beta-adrenergic blockade. Atenolol is beta-1 selective, so risk is generally lower than with nonselective agents, but not absent.
- Onset: Delayed. Evidence: Probable. Severity: Moderate.
- Management: Increase frequency of glucose monitoring; individualize insulin degludec dosing. On beta-blocker withdrawal, watch for loss of glycemic control.
What happens
Hypoglycemia or hyperglycemia; decreased symptoms of hypoglycemia
Interaction Deep Dive
The simultaneous use of antidiabetic medications with beta-blockers can produce either hypoglycemia or hyperglycemia, and may also mask the warning signs of hypoglycemia23. Among those warning signs, tachycardia can be affected, whereas others such as dizziness and sweating are not 1. Beta-blockers that are nonselective have the potential to intensify hypoglycemia caused by insulin and to hinder the restoration of serum glucose concentrations. In individuals with both heart failure and diabetes, hyperglycemia may worsen 7. It may become necessary to monitor glucose more often or to modify the dose of the antidiabetic drug 23. During concurrent administration, watch carefully for indications of hypoglycemia, and should the beta-blocker be discontinued, monitor for a loss of glycemic control 4.
Why it happens (mechanism)
Altered glucose metabolism and beta blockade
How to manage this interaction
This is a manageable combination, and you should keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Monitor more often: Your team may ask you to check your blood sugar more frequently, especially when starting or changing either drug.
- Know your low-sugar signs: Since a racing heartbeat may be blunted, watch for sweating, hunger, confusion, or weakness.
- Dose tailoring: Your insulin degludec dose may need to be adjusted and individualized by your care team based on your readings.
- If atenolol is stopped: Tell your team, as your blood sugar control may shift.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Among elderly diabetic patients receiving either insulin or sulfonylureas, the selection of antihypertensive agent had minimal influence on hypoglycemia risk; however, once other risk factors were taken into account, the lowest risk was associated with cardioselective beta blockers and the highest with non-cardioselective beta blockers, while the remaining antihypertensive agents fell in between (N=13,559) 5.
b) In patients with hypertension and non-insulin dependent diabetes, beta blockers produced a worsening of long-term glycemic control, whereas alpha blockade and ACE inhibitors did not. Some detrimental changes in the lipid profile were also seen with beta blockade. These effects were particularly evident with propranolol. Using an alpha blocker together with the beta blocker prevented the worsening caused by beta blockade 6.
Common questions
Can I take Insulin Degludec and Atenolol together?
Atenolol can hide the racing-heartbeat warning of low blood sugar and can shift your glucose control, so check your sugars more often and keep your care team informed. Keep taking both as prescribed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Insulin Degludec and Atenolol interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Insulin Degludec and Atenolol interaction managed?
This is a manageable combination, and you should keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Monitor more often: Your team may ask you to check your blood sugar more frequently, especially when starting or changing either drug. Know your low-sugar signs: Since a racing heartbeat may be blunted, watch for sweating, hunger, confusion, or weakness. Dos… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Insulin Degludec or Atenolol need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (7)
- Product Information: TENORMIN(R) oral tablets, atenolol oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2012. DailyMed
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: Glynase(R) PresTab(R) oral micronized tablets, glyburide oral micronized tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2013. DailyMed
- Shorr RI, Ray WA, Daugherty JR, et al: Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278:40-43. DOI
- Whitcroft IA, Thomas JM, Rawsthorne A, et al: Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics. Horm Metab Res Suppl 1990; 22:42-46.
- Product Information: COREG CR(R) extended-release oral capsules, carvedilol phosphate extended-release oral capsules. GlaxoSmithKline, Research Triangle Park, NC, 2011. DailyMed
Keep reading about Atenolol
Keep reading about Insulin Degludec
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