What's the story on thiazide diuretics?

My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
main med for that is diltiazem, a CCB).

I see that thiazides may increase the risk of diabetes, but there
are also suggestions that that may not be true at low doses, and may
be prevented by keeping potassium levels up, presumably by using
salt substitute or something similar.

My FBG reading immediately before beginning the HCTZ was 107. After
18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
a big breakfast). So it's hard to see much of a negative effect.
Unfortunately, my BP readings at home, which I think are the most
reliable and consistent, were actually up a few points. :-( BUN
and creatinine are also now above the normal range.

Is there a consensus here about thiazides?

"Peabody" <waybackNO784SPAM44@yahoo.com> wrote in message
news:Bh07h.967$nf6.683@newsfe07.phx...
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses, and may
> be prevented by keeping potassium levels up, presumably by using
> salt substitute or something similar.
>
> My FBG reading immediately before beginning the HCTZ was 107. After
> 18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
> a big breakfast). So it's hard to see much of a negative effect.
> Unfortunately, my BP readings at home, which I think are the most
> reliable and consistent, were actually up a few points. :-( BUN
> and creatinine are also now above the normal range.
>
> Is there a consensus here about thiazides?

I don't think you'll find a consensus here about anything! I take that med.
It does raise my BG, but I also need the med for swelling. My friend
surmised that as the diuretic pulls water from our cells it also pulls the
insulin. This could be!

--
See my webpage:
http://mysite.verizon.net/juliebove/index.htm

HCTZ's and diabetes don't mix well

having said that, my Dr has me on 12.5mg of HCTZ
for blood pressure

he won't raise the HCTZ amount any higher
though.... the next increase will have to be the
Accupril portion of my BP meds

kate
--
Join us in the Diabetic-Talk Chatroom on UnderNet
/server irc.undernet.org --- /join #Diabetic-Talk
More info: http://www.diabetic-talk.org/
http://www.diabetic-talk.org/freeveggies.htm
I have no medical qualifications beyond my own
experience.
Choose your advisers carefully, because experience
can be
an expensive teacher.

"Peabody" <waybackNO784SPAM44@yahoo.com> wrote in
message news:Bh07h.967$nf6.683@newsfe07.phx...
> My doc has put me on 12.5 mg of HCTZ to help
with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of
diabetes, but there
> are also suggestions that that may not be true
at low doses, and may
> be prevented by keeping potassium levels up,
presumably by using
> salt substitute or something similar.
>
> My FBG reading immediately before beginning the
HCTZ was 107. After
> 18 days of thiazide, my non-fasting BG was 93
(about 2.5 hours after
> a big breakfast). So it's hard to see much of
a negative effect.
> Unfortunately, my BP readings at home, which I
think are the most
> reliable and consistent, were actually up a few
points. :-( BUN
> and creatinine are also now above the normal
range.
>
> Is there a consensus here about thiazides?
>
>

x-no-archive: yes

Peabody wrote:
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses, and may
> be prevented by keeping potassium levels up, presumably by using
> salt substitute or something similar.

You may want to look into increasing magnesium, as well, after
consulting with your pharmacist.

Susan

Peabody wrote in message ...
>My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
>main med for that is diltiazem, a CCB).
>
>I see that thiazides may increase the risk of diabetes, but there
>are also suggestions that that may not be true at low doses, and may
>be prevented by keeping potassium levels up, presumably by using
>salt substitute or something similar.
>
>My FBG reading immediately before beginning the HCTZ was 107. After
>18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
>a big breakfast). So it's hard to see much of a negative effect.
>Unfortunately, my BP readings at home, which I think are the most
>reliable and consistent, were actually up a few points. :-( BUN
>and creatinine are also now above the normal range.
>
>Is there a consensus here about thiazides?
>

FWIW, many of the better diabetes specialists are asserting that the
"first" blood pressure med for a diabetic ought to be an ACE or ARB. One
may add CCB or diuretics as one wishes after starting with an ACE or ARB.

Regards
Old Al
>

Peabody wrote:
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses

I can't comment there, because I started out with Type 1 diabetes so I
can't "get" it anymore. When I started HCTZ I didn't notice any changes
in bg readings or insulin needs. But potentially just about any food or
medicine has some interaction with diabetes (maybe that's the risk they
talk about.)

> Is there a consensus here about thiazides?

HCTZ works very well for me to keep my bg in the normal to
slightly-below-normal range (where my doc wants it). I was on Altace
before that, and it helped but wasn't enough.

The "TZ" part is a diuretic and I have to try a little harder to keep
hydrated with it.

The "HC" part of HCTZ is an Ace inhibitor (a good thing for many of us
here).

The

They took me off of HCTZ and my Ace Inhibitor when I developed a serum rash.
They tried me on ARB and I developed shortness of breath which my Dr says is
a sign of allergies. I didn't notice and change in my BG on or off HCTZ.
They now have me on Lasix along with atenolol ...My last blood pressure
reading was 118/70.



"oldal4865" <oldal4865@yahoo.com> wrote in message
news:4s3r7tFtl770U1@mid.individual.net...
>
> Peabody wrote in message ...
>>My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
>>main med for that is diltiazem, a CCB).
>>
>>I see that thiazides may increase the risk of diabetes, but there
>>are also suggestions that that may not be true at low doses, and may
>>be prevented by keeping potassium levels up, presumably by using
>>salt substitute or something similar.
>>
>>My FBG reading immediately before beginning the HCTZ was 107. After
>>18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
>>a big breakfast). So it's hard to see much of a negative effect.
>>Unfortunately, my BP readings at home, which I think are the most
>>reliable and consistent, were actually up a few points. :-( BUN
>>and creatinine are also now above the normal range.
>>
>>Is there a consensus here about thiazides?
>>
>
> FWIW, many of the better diabetes specialists are asserting that the
> "first" blood pressure med for a diabetic ought to be an ACE or ARB. One
> may add CCB or diuretics as one wishes after starting with an ACE or ARB.
>
> Regards
> Old Al
>>
>
>

"Peabody" <waybackNO784SPAM44@yahoo.com> wrote in message
news:Bh07h.967$nf6.683@newsfe07.phx...
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses, and may
> be prevented by keeping potassium levels up, presumably by using
> salt substitute or something similar.
>
> My FBG reading immediately before beginning the HCTZ was 107. After
> 18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
> a big breakfast). So it's hard to see much of a negative effect.
> Unfortunately, my BP readings at home, which I think are the most
> reliable and consistent, were actually up a few points. :-( BUN
> and creatinine are also now above the normal range.
>
> Is there a consensus here about thiazides?
>
>

I am on Benicar (an ARB) and Triamterene w/HCTZ for my blood pressure. We
first tried the Benicar alone but it was not enough. Since adding the
Triamterene w\HCTZ my pressures are always below 120/70.

When she added the Triamterene w/HCTZ, she explained to me that Triamterene
is combined with hydrochlorothiazide to treat high blood pressure.
Triamterene does not cause your body to lose potassium the way that many
diuretics do and when combined with HCTZ, prevents excess potassium loss.
She tests my potassium every 3 months and it did not change when I started
the Triamterene w/HCTZ.

Anon

oldal4865 says...

> FWIW, many of the better diabetes specialists are
> asserting that the "first" blood pressure med for a
> diabetic ought to be an ACE or ARB. One may add CCB or
> diuretics as one wishes after starting with an ACE or
> ARB.

Thanks to you and everyone for the repsonses.

I've tried both ACE inhibitors and ARBs, and neither had
much effect at all on my blood pressure. The only thing
that works well for that is the CCB. I suppose a beta
blocker would also be effective, particularly since my
problem is entirely systolic, but I refuse to take one of
those.

After a couple weeks on the HCTZ, my BP readings at home
are actually a little higher than they were before. But I
need to do more checking on that.

Anyway, it sounds like 12.5 mg HCTZ isn't likely to cause
significant problems.

Hydrochlorothiazide was the first BP drug I was put on before I had
insurance. It was cheap. I had to drink this awful red liquid potassium
supplement. I was forever low in potassium. The whole process was miserable.
Later I was put on a potassium conserving diruetic whose name I forget.


"Peabody" <waybackNO784SPAM44@yahoo.com> wrote in message
news:Bh07h.967$nf6.683@newsfe07.phx...
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses, and may
> be prevented by keeping potassium levels up, presumably by using
> salt substitute or something similar.
>
> My FBG reading immediately before beginning the HCTZ was 107. After
> 18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
> a big breakfast). So it's hard to see much of a negative effect.
> Unfortunately, my BP readings at home, which I think are the most
> reliable and consistent, were actually up a few points. :-( BUN
> and creatinine are also now above the normal range.
>
> Is there a consensus here about thiazides?
>
>

Peabody wrote:
> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
> main med for that is diltiazem, a CCB).
>
> I see that thiazides may increase the risk of diabetes, but there
> are also suggestions that that may not be true at low doses, and may
> be prevented by keeping potassium levels up, presumably by using
> salt substitute or something similar.

Thiazides do tend to increase insulin resistance so they are not the
wisest choice for folks with type-2 diabetes.

> My FBG reading immediately before beginning the HCTZ was 107. After
> 18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
> a big breakfast). So it's hard to see much of a negative effect.
> Unfortunately, my BP readings at home, which I think are the most
> reliable and consistent, were actually up a few points. :-( BUN
> and creatinine are also now above the normal range.

The latter would suggest worsening renal unsufficiency. This would
explain why your non-fasting BG has been decreasing because the
half-life of insulin increases with worsening renal insufficiency.
This would also explain your lack of response to the HCTZ, which
depends on normal kidney function to work at lowering blood pressure.

> Is there a consensus here about thiazides?

It should be avoided in type-2 diabetics especially when the kidneys
are not working normally.

May GOD continue to heal your heart by curing your diabetes, dear
neighbor Peabody whom I love unconditionally.

Prayerfully in Christ's amazing love,

Andrew <><
--
Andrew B. Chung
Cardiologist, Atlanta, Georgia, USA
http://HeartMDPhD.com/HolySpirit

As for knowing who are the very elect, these you will know by the
unconditional love they have for everyone including their enemies
(Matthew 5:44-45, 1 Corinthians 13:3, James 2:14-17).
http://HeartMDPhD.com/Love

Andrew B. Chung, MD/PhD says...

>> My FBG reading immediately before beginning the HCTZ
>> was 107. After 18 days of thiazide, my non-fasting BG
>> was 93 (about 2.5 hours after a big breakfast). So
>> it's hard to see much of a negative effect.
>> Unfortunately, my BP readings at home, which I think
>> are the most reliable and consistent, were actually up
>> a few points. :-( BUN and creatinine are also now
>> above the normal range.

> The latter would suggest worsening renal unsufficiency.
> This would explain why your non-fasting BG has been
> decreasing because the half-life of insulin increases
> with worsening renal insufficiency. This would also
> explain your lack of response to the HCTZ, which depends
> on normal kidney function to work at lowering blood
> pressure.

Thanks for the reponse, Andrew. Here are the actual
numbers:

Before = 10/25/06 Fasting
After = 11/15/06 Non-fasting, after 18 days on HCZT 12.5mg

Values shown are Before/After [Range]

Glucose 107 / 93 [70-110]
BUN 22 / 26 [6-20]
Creatinine 1.3 / 1.4 [0.5-1.3]
Na 135 / 134 [133-145]
K 4.6 / 4.7 [3.3-5.1]

It appears the biggest change was BUN, but remember that the
second test was non-fasting, and after a fairly high-protein
breakfast. I just noticed that potassium was actually up.
Very strange.

Also, the only official indication I've had of possible
type-2 diabetes was one FBG result of 114 a year ago. Tests
since then , and for 10 years before then, have been in the
105-108 range.

Well, if it continues to provide no decrease in BP, then
I'll drop it. But if it does eventually lower BP, are you
saying I still shouldn't take it in view of the above test
results?

When I had my adrenal problem I was put on ..Spironolactone it is a
diuretic that can be used for low potassium. ..and I was put on 6 potassium
pills a day and they still couldn't keep my potassium up...that was one
reason they did another CatScan which showed I had a tumor. The lowest my
potassium got was 2.4....except for after they took the bad adrenal out and
it took the good adrenal about 24 hours to start working again...the night
after surgery my potassium bottomed out and I felt like a four hundred pound
brick was put on my chest...I knew what that was and it scared me something
awful. That was when they finally decided to call the pharmacy..even though
my Dr had given the order as soon as I came up from recovery. I hate it
when my Dr tells me to eat a banana or drink a glass of OJ a day...I remind
her of the carb count. I still have potassium pills and when I feel
palpitations(one of the signs I get when my potassium is low) I will take
one.
--
Jacquie
"Uncle Enrico" <Uncle@nospam.com> wrote in message
news:WaH7h.8062$6t.172@newssvr11.news.prodigy.com. ..
> Hydrochlorothiazide was the first BP drug I was put on before I had
> insurance. It was cheap. I had to drink this awful red liquid potassium
> supplement. I was forever low in potassium. The whole process was
> miserable. Later I was put on a potassium conserving diruetic whose name I
> forget.
>
>
> "Peabody" <waybackNO784SPAM44@yahoo.com> wrote in message
> news:Bh07h.967$nf6.683@newsfe07.phx...
>> My doc has put me on 12.5 mg of HCTZ to help with blood pressure (my
>> main med for that is diltiazem, a CCB).
>>
>> I see that thiazides may increase the risk of diabetes, but there
>> are also suggestions that that may not be true at low doses, and may
>> be prevented by keeping potassium levels up, presumably by using
>> salt substitute or something similar.
>>
>> My FBG reading immediately before beginning the HCTZ was 107. After
>> 18 days of thiazide, my non-fasting BG was 93 (about 2.5 hours after
>> a big breakfast). So it's hard to see much of a negative effect.
>> Unfortunately, my BP readings at home, which I think are the most
>> reliable and consistent, were actually up a few points. :-( BUN
>> and creatinine are also now above the normal range.
>>
>> Is there a consensus here about thiazides?
>>
>>
>
>