Ask Joslin: Diuretics

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ask joslin featured imageAre Diuretics Bad for People with Diabetes/Prediabetes?

The short answer is some are; some aren’t. But it’s a little more complicated than that. Diuretics are medications that pull water out of the blood vessels subsequently lowering high blood pressure. This process is called “diuresis” which simply means “to make urine”. They are most often prescribed for hypertension (high blood pressure) but can also be used to treat liver cirrhosis, and certain kidney diseases.
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“Diuretic” is an umbrella term, but there are distinct groups of drugs that pull water out of the body in different ways. The group most associated with increased risk of diabetic complications was thiazides and thiazide-like diuretics.

Even though thiazides have the potential for complications, Robert Gabbay, M.D., Ph.D., Chief Medical officer and Vice President of the Joslin Diabetes Center, warns that patients shouldn’t jump to conclusions.
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“These drugs are a valuable, cost effective way to control blood pressure,” he says. “It’s important to ask your provider to see if the drug may be a problem for you or if the benefits outweigh the risks.”

  1. High ceiling/loop diuretic: These cause the most substantial diuresis, pulling up to 20 percent of retained water and salt out of the body and into the urine. It also prevents the reabsorption of salt into the body, keeping blood pressure very low. Furosemide is one of the most common high ceiling/loop diuretics (marketed under Lasic®, Frumex® and Fusid®). These extreme diuretics are usually prescribed to treat congestive heart failure and edema.
  2. Thiazides and thiazide-like diuretics: Thiazides stop the kidneys from reabsorbing salt ions. The process of salt absorption is usually accompanied by water reabsorption. Because this process is blocked, the water remains in the urine and gets flushed from the system. These compounds are often prescribed for long term hypertension management. One of the side effects of thiazides and thiazide-like diuretics is hyperglycemia. Scientists, including those from Joslin , have shown thiazides can increase the risk of developing diabetes as well as worsen symptom for those already living with the disease. For a comprehensive list of generic and brand name thiazides and thiazide like drugs, see below.
  3. Carbonic anhydrase inhibitors: These inhibit the enzyme carbonic anhydrase which is found in a tiny section of the kidneys. Blocking this enzyme promotes bicarbonate retention in the urine, potassium retention in urine and decreased sodium absorption. Drugs in this class include acetazolamide and methazolamide. It is commonly prescribed for glaucoma, epilepsy, altitude sickness, and edema.
  4. Potassium-sparing diuretics: These are diuretics which do not promote the secretion of potassium into the urine; thus, potassium is retained and not as much is lost as with other diuretics. Spironolactone, triamterene and amiloride are three types of these weaker diuretics. They are often prescribed with other, stronger diuretics to boost effectiveness.
  5. Osmotic diuretics: These compounds are usually sugars. They cause an increase of ions in the blood which causes the body to pull out moisture in an attempt to flush them out. Manntiol and glucose are both osmotic diuretics. These compounds are used as emergency “osmotherapy” which shortly reduces blood pressure until a more substantial treatment can be given.

Dr. Robert Gabbay, Chief Medical Officer of Joslin Since many older adults are on multiple medications, it is always important to inform your doctor about everything you are taking—even if it was prescribed by a different doctor and seems unrelated. If you know you’re on diuretics but are unsure if it is a thiazide/thiazide-like diuretic, check our list below. If you are on diuretics and are worried about developing diabetes or exacerbating complications if you already have diabetes, talk to your doctor. They may be able to more-closely monitor your blood sugar levels and catch any problems before they become serious.

“Diuretics are an important tool in the control of blood pressure and are well tolerated by the vast majority of individuals,” says Dr. Gabbay. “But if you’re worried about developing diabetes, the best way to prevent it is maintaining a healthy body weight through portion control of their diet and through regular exercise.”
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Thiazides and Thiazide-like Pharmaceuticals
generic name: bendroflumethiazide
brand names: Naturetin®

generic name: chlorothiazide
brand names: Diuril®, Diruil Sodium®, Thalitone®

generic name: hydrochlorothiazide
brand names: Esidrix®, Microzide®, Aquazide H®, HydroDIURIL®, Saluron®

generic name: indapamide
brand names: Lozol®

generic name: methyclothiazide
brand names: Aquatensen®, Enduron®

generic name: metolazone
brand names: Zaroxolyn®, Mykrox®

generic name: polythiazide
brand names: Renese®



One Response to Ask Joslin: Diuretics

  1. Gary Gorlick,MD says:

    Re Lupron depot injections 22.5 mg q 3 months.
    Q: can the above DRAMATICALLY increase blood glucose? From values of 150 going to 450?

    Please reply. Thank you.

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