Diuretics are drugs that are used to lower blood pressure. This is mainly done by getting the body to rid itself of excess fluids and sodium through urination. They may be combined with other medications if diuretics alone are unable to bring the desired effects. It has been seen that in diabetics, diuretic drugs may cause blood sugar levels to rise. Generally a few changes in drug, diet, insulin or oral anti-diabetic dosage can help correct this in most cases. When prescribing the medication the doctor can change your treatment after considering the relationship between diuretics and blood glucose levels if you inform him of your diabetic status.
Diuretics and blood glucose levels
A clinical trial conducted in 2002, known as ALLHAT showed that an old, inexpensive diuretic (chlorthalidone) was good at lowering blood pressure and reducing the risk for heart attack and heart-related deaths. Other effective but expensive drugs included a calcium-channel blocker (amlodipine) and an ACE inhibitor (lisinopril). The diuretic was found better at preventing heart failure. The recommendations based on the ALLHAT results included having thiazide diuretic as the first drug or at least as a part of combination therapy for a person trying to control blood pressure.
A new study of the ALLHAT data also shows another interesting result. An increase in blood sugar levels over the course of the trial in people taking any of the three drugs. The study of data on glucose levels over six years showed that increase was largest among those taking the diuretic. It was almost 13mg/L among those taking the diuretic and lowest at 9.3mg/dL among those taking the ACE inhibitor. Moreover diabetes developed in 14% of those taking the diuretic, 11% of those taking the calcium-channel blocker, and 9.5% of those taking the ACE inhibitor.
Diabetes is a major promoter of heart disease. High levels of blood sugar and insulin cause damage to the circulatory system which often leads to cardiovascular conditions like heart attack, stroke, heart failure, high blood pressure etc. However, the interesting thing that came up in the ALLHAT study was that the people taking the diuretic chlorthalidone and who developed diabetes were not at any higher risk of having one or more of these cardiovascular problems than people who didn’t develop diabetes. However, those taking the ACE inhibitor or calcium-channel blocker and who developed diabetes were at increased risk of having a heart attack.
The ALLHAT results can safely be interpreted as an indicator that diuretic-induced diabetes may be less harmful than regular diabetes, or may even be harmless. Another study or follow-up of the volunteers in a clinical trial for 14 years where comparison of chlorthalidone against a placebo in older individuals showed no increase in heart disease, stroke, or premature death in chlorthalidone-taking volunteers who had developed diabetes.
The studies do make the case for having your blood sugar tested regularly every year or so when you are taking any medication to lower your blood pressure. If you see your blood sugar level in an increasing trend you should consult with your doctor about the intensity of treatment that is required for the blood pressure medication you are taking. Diuretic is not suited for all, but it is a good first option for many people. If you need two or three medications to lower your blood pressure, a diuretic should probably be one of them.
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