From a molecular level, this is perhaps explained by the fact that the pancreatic b-cell secretion of insulin is regulated in large part by ATP-sensitive K channels in the beta-cell membrane. Alterations in the extracellular potassium concentration to which these cells are exposed could potentially lead to decreased insulin secretion.
If this mechanism is correct, it would imply that thiazide-induced hyperglycemia occurs by a different mechanism decreased insulin secretion than the standard type 2 diabetes peripheral insulin resistance , and furthermore that thiazide-induced hyperglycemia is reversible with normalization of potassium levels.
Thus, it is probably not necessary to remove thiazides from the list of useful first-line agents for treatment of hypertension. That being said, as a budding nephrologist I am always looking for a good reason to prescribe an ACE-inhibitor or ARB, and therefore I personally tend to add one of the RAAS blockers first given the population of clinic patients that I see.
Save my name, email, and website in this browser for the next time I comment. Follow ASNKidney. So why would medicines for high blood pressure be prescribed for diabetics who do not suffer from hypertension?
As you know, diabetes is one of the leading causes of kidney failure. We know that as the kidneys fail, more protein is spilled in the urine. Certain types of blood pressure medicines reduce the pressure in the kidneys, thereby reducing the amount of protein they excrete.
Through this process, kidney failure may be delayed or averted altogether. The classes of blood pressure medicines that have been proven to have such an effect are ACE inhibitors lisinopril , ramipril , enalapril and captopril , angiotensin II inhibitors irbesartan , telmisartan , losartan , and a specific subclass of calcium channel blockers diltiazem , verapamil.
I suspect your doctor started an antihypertensive to protect your kidneys. Next time you visit, ask your doctor if this is the case. By subscribing you agree to the Terms of Use and Privacy Policy. Health Topics. Health Tools.
Type 2 Diabetes. Hall JJ et al. Thiazide diuretic—induced change in fasting plasma glucose: A meta-analysis of randomized clinical trials. J Gen Intern Med Jun; J Gen Intern Med Jun However, the change is not large enough to be clinically meaningful in most patients.
Comment In this meta-analysis, thiazide use caused a small, but clinically unimportant, mean increase in FBG. Citation s : Hall JJ et al. Disclosures Disclosures for Paul S.
Topics Diabetes Hypertension. October 24, Surgery, Plastic.
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