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Why Thiazides Are Contraindicated In Diabetes

Why Do Thiazides Decrease Polyuria In Diabetes Insipidus?

Why Do Thiazides Decrease Polyuria In Diabetes Insipidus?

I was reviewing the treatment of diabetes insipidus the other day, and was reminded of the paradoxical effect of thiazide diuretics on urine output in diabetes insipidus. How does this work? The traditional thinking is that thiazide-induced blockade of the Na-Cl cotransporter in the distal tubule leads to a decrease in GFR. This decrease is compensated by an increase in proximal tubule sodium and water uptake. Because less water and solute are then delivered to the collecting duct, less water is lost as urine. However, some studies suggest that chronic use of thiazides does not result in a decrease in extracellular fluid volume: cardiac output returns to normal several weeks after initiating therapy, and infusion of salt-free dextran does not increase blood pressure. Studies in rats with central DI have also shown that replacement of renal sodium losses does not prevent the antidiuretic effect of thiazides. Experiments by Kim et al. suggest that thiazides may serve to upregulate aquaporin channels and ENaC subunits. In rates with lithium-induced nephrogenic DI, HCTZ reversed lithium-induced downregulation of AQP2. It also caused an increase in the abundance of ENaC channels. While these results are specific to Li-induced renal effects, they may at least partially explain how a thiazide can serve to decrease polyuria in patients with diabetes insipidus. Continue reading >>

Hydrochlorothiazide & Blood Glucose

Hydrochlorothiazide & Blood Glucose

Roseanne Omalacy became a published author and freelance writer in 2006. She is the author of several novels and has been published with Literary Partners Group, Alyson Publishing and "Scarlet Magazine." She is a Pittsburgh health and relationships columnist, holds a bachelor's degree in nursing from Pennsylvania State University and has over 15 years of nursing experience. A man is filling a syringe with insulin.Photo Credit: Images_By_Kenny/iStock/Getty Images Hydrochlorothiazide is a diuretic that treats water retention by reducing the amount of salt absorbed by the body. This is especially important in patients with high blood pressure, kidney disorders and diabetes. Diabetes is a metabolic disease characterized by high levels of sugar in the bloodstream. Diabetes increases your risk of heart disease, blindness and stroke. Combining certain medications with diabetes can cause adverse reactions, so you must know how hydrochlorothiazide affects your blood sugar. Insulin is a hormone produced by the pancreas that changes food into energy. When your cells become resistant to insulin or your pancreas quits making insulin, diabetes can develop. There are two kinds of diabetes, but diabetes type 2 is the most common form of the disease. As of 2011, more than 25 million Americans have diabetes, according to the American Diabetes Association. Symptoms of diabetes include increased thirst, vision changes, hunger and increased urination. Diabetes increases your risk of stroke, heart disease, blindness and kidney disease. Physicians treat diabetes with dietary changes, oral medications and insulin injections. Diuretics are a family of drugs used to treat fluid retention associated with kidney disease, heart disease, diabetes and other disorders. Diuretics are sometimes called Continue reading >>

Drug Interactions With Diabetes

Drug Interactions With Diabetes

Patients with diabetes often receive many other medications in addition to their oral or injectable diabetes agents. If confronted with a loss of glycemic control, providers should investigate whether or not concomitant drug therapy may be contributing. This is of particular consideration when starting a new medication or increasing dosages. The theorized mechanisms for these interactions include decreased peripheral insulin sensitivity, decreased insulin secretion and/or increased gluconeogenesis. This article summarizes information on a core group of medications to be suspected in cases of decreased glycemic control. Corticosteroids The route of administration and the dose are factors that determine the impact of this class on blood glucose. Lower risk is associated with inhaled and topical formulations vs. oral formulations. The effect on blood glucose may be dramatic and prolonged, requiring dose increases in diabetes medications to achieve glycemic control during concomitant therapy. Atypical antipsychotics These medications have been frequently reported to be associated with significant increases in weight, diabetes (even diabetic ketoacidosis) and may have an adverse effect on lipids. The weight gain appears to be rapid, within the first few months of therapy, but may not plateau for as long as one year after treatment initiation. The increase in weight is widely variable (2 to 10 kg) and is reportedly due to an increase in body fat, suggesting insulin resistance as the mechanism. The relative risk of hyperglycemia and weight gain varies between agents within this class. Clozapine (Clozaril, Novartis) and olanzepine (Zyprexa, Eli Lilly) appear to be ranked highest. Switching patients to the lowest risk agents aripiprazole (Abilify, Otsuka America/Bristol-Myers Sq Continue reading >>

Thiazide Diuretics And Risk Of Diabetes Mellitus - General Practice Notebook

Thiazide Diuretics And Risk Of Diabetes Mellitus - General Practice Notebook

thiazide diuretics and risk of diabetes mellitus in the ALLHAT study, the first-line use of a thiazide diuretic, an angiotensin-converting enzyme (ACE) inhibitor, or a calcium-channel blocker (CCB) for hypertension was similarly effective in reducing the risk of major cardiovascular (CV) events CCBs were less effective in preventing heart failure than thiazide diuretics, whereas development of diabetes (defined as fasting blood glucose levels [FGs] above 6.9mmol/l) was more frequent with thiazide diuretics than with CCBs a post-hoc subgroup analysis considered non-diabetic patients in ALLHAT who were randomised to initially receive chlortalidone (n=8,419), amlodipine (n=4,958), or lisinopril (n=5,034) (2) after two years, mean FGs were raised in all groups by 0.47mmol/l, 0.31mmol/l and 0.19mmol/l, respectively more cases of incident diabetes, when defined by a 6.9mmol/l FG threshold, were detected in the chlortalidone group - however, absolute differences between groups in incident diabetes were small (chlortalidone 9.3%, amlodipine 7.2%, lisinopril 5.6%) risk of developing diabetes was lower for lisinopril (odds ratio [OR] 0.55, 95%CI 0.43 to 0.70, P<0.001) or amlodipine (OR 0.73, 95%CI 0.58 to 0.91, P=0.008) compared with chlortalidone was no significant association between FG changes at two years and any of the study endpoints (death, CV disease or end-stage renal disease), whether analysed for all treatments combined or for chortalidone alone findings support the results from the 14-year follow-up of SHEP (3) and suggest that, even if diabetes does occur during the treatment of hypertension with thiazide diuretics, this does not create any greater cardiovascular risk possible that that the raised FGs that occur with thiazide diuretics arise from mechanisms that are Continue reading >>

Controlling Hypertension In Patients With Diabetes

Controlling Hypertension In Patients With Diabetes

Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Nearly one in four adults in the United States has hypertension, and more than 10 million adults have diabetes.1 Moreover, hypertension is twice as common in persons with diabetes as it is in others.2 Obesity may be a common link between the two disorders, but other factors such as insulin resistance3 and autonomic dysfunction4 may also be involved. Excess weight with truncal obesity, hypertension, impaired glucose tolerance, insulin resistance, and dyslipidemia are among the components of the metabolic syndrome, which has been associated with an increased risk of coronary heart disease.5 In general, only 25 percent of patients with hypertension have adequate control of their blood pressure.6 Blood pressure goals are lower, and thus more difficult to achieve, in patients who also have diabetes. Elevated blood pressure is known to contribute to diabetic microvascular and macrovascular complications (Table 1).4,7,8 Fortunately, reductions in blood pressure can decrease the risk of these complications.8 TABLE 1 Microvascular complications Renal d Continue reading >>

Drug Induced Diabetes

Drug Induced Diabetes

Tweet A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes. In some cases the development of diabetes may be reversible if use of the medication is discontinued, but in other cases drug-induced diabetes may be permanent. Drug induced diabetes is a form of secondary diabetes, in other words diabetes that is a consequence of having another health condition. Which drugs can induce diabetes? A number of drugs have been linked with an increased risk development of type 2 diabetes. Corticosteroids Thiazide diuretics Beta-blockers Antipsychotics Is diabetes permanent? Diabetes may not be permanent but this can depend on other health factors. With some medications, blood glucose levels may return back to normal once the medication is stopped but, in some cases, the development of diabetes may be permanent. Managing drug induced diabetes If you need to continue taking the medication that has brought on diabetes, it may make your diabetes more difficult to control than would otherwise be the case. If you are able to stop the course of medication, you may find your blood glucose levels become slightly easier to manage. Following a healthy diet and meeting the recommended exercise guidelines will help to improve your chances of managing your blood glucose levels. Can drug induced diabetes be prevented? It may be possible to reduce the risk of developing diabetes by ensuring you to keep to a healthy lifestyle whilst you are on the medication. Being on smaller doses of the medication or shorter periods of time may help to reduce the likelihood of developing high blood sugar levels and diabetes. Doctors will usually try to put you on the smallest e Continue reading >>

Diuretic-related Side Effects: Development And Treatment

Diuretic-related Side Effects: Development And Treatment

Please confirm that you would like to log out of Medscape.If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Diuretic-Related Side Effects: Development and Treatment Prolonged thiazide diuretic therapy can lead to glucose intolerance and may occasionally precipitate diabetes mellitus.[ 4 , 5 , 54 , 55 ] Short-term metabolic studies, epidemiologic studies, and a variety of clinical trials suggest a connection between ongoing thiazide diuretic use and the development of type 2 diabetes. However, it should be noted that interpretation of these studies is confounded by multiple factors including: differing definitions of new-onset diabetes, small numbers of patients, inadequate comparison groups, relatively limited periods of follow-up, selection criteria that limited the generalizability of the findings, and study designs that prohibited valid comparisons among antihypertensive drug classes.[ 56 ] Moreover, in a review of all the placebo-controlled hypertension trials with diuretics, there was only an approximate 1% increase in new-onset diabetes compared with placebo.[ 57 ] Hyperglycemia and carbohydrate intolerance have been linked to diuretic-induced hypokalemia. K+ deficiency is known to inhibit insulin secretion by cells; however, diuretic-induced changes in glucose metabolism are not conclusively related to altered K+ homeostasis, and impaired glucose tolerance occurs even when thiazide-type diuretics in relatively low doses are combined with K+ -sparing agents. The glucose intolerance seen with diuretic therapy can deteriorate further with an increase in sympathetic nervous system activity, which also decreases peripheral glucose utilization. Diuretic-associated glucose intolerance appears to be dose-rel Continue reading >>

Treatment Of Hypertension In Patients With Diabetes Mellitus

Treatment Of Hypertension In Patients With Diabetes Mellitus

INTRODUCTION AND PREVALENCE Hypertension is a common problem in patients with both type 1 and type 2 diabetes, but the time course in relation to the duration of diabetes is different [1-3]. Among those with type 1 diabetes, the incidence of hypertension rises from 5 percent at 10 years, to 33 percent at 20 years, and 70 percent at 40 years [1]. There is a close relation between the prevalence of hypertension and increasing albuminuria. The blood pressure typically begins to rise within the normal range at or within a few years after the onset of moderately increased albuminuria (the new term for what was previously called "microalbuminuria") [2] and increases progressively as the renal disease progresses. (See "Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus", section on 'Risk factors'.) These features were illustrated in a study of 981 patients who had type 1 diabetes for five or more years [3]. Hypertension was present in 19 percent of patients with normoalbuminuria, 30 percent with moderately increased albuminuria, and 65 percent with severely increased albuminuria (the new term for what was previously called "macroalbuminuria") [2]. The incidence of hypertension eventually reaches 75 to 85 percent in patients with progressive diabetic nephropathy [4]. The risk of hypertension is highest in blacks, who are also at much greater risk for renal failure due to diabetic nephropathy. (See "Overview of diabetic nephropathy".) The findings are different in patients with type 2 diabetes. In a series of over 3500 newly diagnosed patients, 39 percent were already hypertensive [5]. In approximately one-half of these patients, the elevation in blood pressure occurred before the onset of moderately increased albuminuria. Hypertension was strongly a Continue reading >>

Hydrochlorothiazide (hctz) Tablets

Hydrochlorothiazide (hctz) Tablets

Pharmacological Classifications: Thiazide Diuretic General Information:Hydrochlorothiazide (HCTZ) is a thiazide diuretic used in the management of edema and hypertension. In hypertension, thiazide diuretics are often used as initial therapy, either alone or in combination with other agents. Unlike the loop diuretics, their efficacy is diminished in patients with renal insufficiency. Hydrochlorothiazide also has been used to treat diabetes insipidus and hypercalciuria, although these are not FDA-approved indications. Hydrochlorothiazide was approved by the FDA in 1959. Mechanism of Action:Thiazide diuretics increase the excretion of sodium, chloride, and water by inhibiting sodium ion transport across the renal tubular epithelium. Although thiazides may have more than one action, the major mechanism responsible for diuresis is to inhibit active chloride reabsorption at the distal portion of the ascending limb or, more likely, the early part of the distal tubule (i.e., the cortical diluting segment). Exactly how chloride transport is impaired is unknown. Thiazides also increase the excretion of potassium and bicarbonate, and they decrease the urinary excretion of calcium and uric acid. Hydrochlorothiazide may be used to reduce hypercalciuria and prevent the recurrence of calcium-containing renal calculi. By increasing the sodium load at the distal renal tubule, hydrochlorothiazide indirectly increases potassium excretion via the sodium-potassium exchange mechanism. Hypochloremia and hypokalemia can cause mild metabolic alkalosis. The diuretic efficacy of hydrochlorothiazide is not affected by the acid-base balance of the patient. Hydrochlorothiazide is not an aldosterone antagonist, and its main action is independent of carbonic anhydrase inhibition. The antihypertensive Continue reading >>

Hydrochlorothiazide Disease Interactions

Hydrochlorothiazide Disease Interactions

Severe Potential Hazard, High plausibility The use of thiazide diuretics is contraindicated in patients with anuria. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO. Thiazides (Includes Hydrochlorothiazide) Electrolyte Losses Severe Potential Hazard, High plausibility Applies to: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrol Continue reading >>

Thiazide And Beta-blocker Use Linked With Increased Risk For Incident Diabetes

Thiazide And Beta-blocker Use Linked With Increased Risk For Incident Diabetes

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [emailprotected] Instructions for Participation and Credit There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. Follow these steps to earn CME/CE credit*: Read the target audience, learning objectives, and author disclosures. Study the educational content online or printed out. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming. You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage. *The credit that you receive is based on your user profile. CME Released: 5/8/2006; Reviewed and Renewed: 5/8/2007 May 8, 2006 Thiazide diuretics and beta-blockers appear to be associated with an increased relative risk for incide Continue reading >>

Thiazide Diuretics | Uses And Side Effects | Patient

Thiazide Diuretics | Uses And Side Effects | Patient

A diuretic is a medicine which increases the amount of water that you pass out from your kidneys. (A diuretic causes an increase in urine, called a diuresis.) So, they are sometimes called 'water tablets'. There are different types of diuretics which work in different ways and thiazide diuretics are one type of diuretic. Thiazide diuretics are a common treatment for high blood pressure (hypertension) . They are also used to clear fluid from the body in conditions where your body accumulates too much fluid, such as heart failure. (However, a type of diuretic called a loop diuretic is more commonly used to treat heart failure.) There are a number of thiazide diuretics - they include bendroflumethiazide , chlortalidone , cyclopenthiazide , indapamide and xipamide . Each comes in a different brand name. One of their effects is to make the kidneys pass out more fluid. They do this by interfering with the transport of salt and water across certain cells in the kidneys. Thiazide diuretics tend to have only a weak action on the kidneys so you don't notice a great increase in urine if you take these (compared with loop diuretics). They also have the effect of widening (dilating) blood vessels. A combination of these two effects reduces the blood pressure. Side-effects are uncommon, as the dose needed to lower blood pressure is low. The leaflet which comes in the tablet packet provides a full list of possible side-effects. So, it is important to read that leaflet if you are prescribed a thiazide diuretic. Common or serious possible side-effects include: A possible increase in your blood sugar level. Some people with diabetes may need more treatment to keep the blood sugar level normal. A possible increase in the level of uric acid. So, if you have gout, you may have more gout at Continue reading >>

Diuretics May Increase Diabetes Risk By Lowering Blood Potassium Levels

Diuretics May Increase Diabetes Risk By Lowering Blood Potassium Levels

Diuretics may increase diabetes risk by lowering blood potassium levels Posted on Nov 25, 2008, 6 a.m. By Rich Hurd New research suggests that depleted blood potassium levels could help to explain why people prescribed diuretics for the treatment of high blood pressure are at increased risk of type 2 diabetes. New research suggests that depleted blood potassium levels could help to explain why people prescribed diuretics for the treatment of high blood pressure are at increased risk of type 2 diabetes. Tariq Shafi and colleagues examined data from 3,790 non-diabetic participants in the Systolic Hypertension in Elderly Program (SHEP), a study designed to determine the risk versus benefit of treating people age 60 years or older with the thiazide diuretic chlorthalidone. Previous research has shown that treatment with thiazide diuretics causes potassium levels to drop and increases patients' risk of developing type 2 diabetes by as much as 50%, although whether the drop in blood potassium was linked to the increased risk of diabetes was uncertain. Results of this study suggest that the increased risk of type 2 diabetes associated with thiazide diuretics is indeed linked to their action on blood potassium levels. In fact, results showed that for each 0.5 milliequivalent-per-liter (MEq/L) decrease in serum potassium, there was a 45% increased risk of diabetes . Thiazides are effective at treating high blood pressure and are inexpensive, however their association with diabetes has led many doctors to prescribe other, more expensive, drugs. However, according to Dr Shafi, the study findings suggest that thiazides can be used safely as long as doctors monitor and regulate blood potassium levels. The authors speculate that potassium supplement may prevent thiazide-induced diab Continue reading >>

Drugs That Can Worsen Diabetes Control

Drugs That Can Worsen Diabetes Control

One of the main goals of any diabetes control regimen is keeping blood glucose levels in the near-normal range. The cornerstones of most plans to achieve that goal include following a healthy diet, getting regular exercise, and taking insulin or other medicines as necessary. However, it’s not uncommon for people with diabetes to have other medical conditions that also require taking medicines, and sometimes these drugs can interfere with efforts to control blood glucose. A few medicines, including some commonly prescribed to treat high blood pressure and heart disease, have even been implicated as the cause of some cases of diabetes. This article lists some of the medicines that can worsen blood glucose control, the reasons they have that effect, the usual magnitude of the blood glucose changes, as well as the pros and cons of using these drugs in people who have diabetes. Where the problems occur To understand how various medicines can worsen blood glucose control, it helps to understand how insulin, the hormone responsible for lowering blood glucose, works in the body. Insulin is released from the beta cells of the pancreas in response to rising levels of glucose in the bloodstream, rising levels of a hormone called GLP-1 (which is released from the intestines in response to glucose), and signals from the nerve connections to the pancreas. The secretion of insulin occurs in two phases: a rapid first phase and a delayed second phase. Both of these phases are dependent on levels of potassium and calcium in the pancreas. Insulin acts on three major organs: the liver, the muscles, and fat tissue. In the liver, insulin enhances the uptake of glucose and prevents the liver from forming new glucose, which it normally does to maintain fasting glucose levels. In muscle and f Continue reading >>

Beta-blockers For The Treatment Of Hypertension In Patients With Diabetes: Exploring The Contraindication Myth

Beta-blockers For The Treatment Of Hypertension In Patients With Diabetes: Exploring The Contraindication Myth

, Volume 13, Issue5 , pp 435439 | Cite as Beta-blockers for the Treatment of Hypertension in Patients with Diabetes: Exploring the Contraindication Myth Purpose: To review the evidence supporting the contraindications (hypoglycemic unawareness, insulin resistance, and dyslipidemia) usually given as the reasons by physicians for not using beta blockers for treating hypertension in patients with diabetes mellitus. Methods: A research synthesis based on MEDLINE (January 1966 through January 1999), hand searches of pertinent references and textbooks, and consultation with experts. Results: There is little evidence to support the assertion that beta blockers should be routinely contraindicated in diabetes. Beta blockers have few clinically important effects on hypoglycemic awareness and recovery, insulin resistance and hyperglycemia, or lipid profiles. Moreover, when diabetics have been treated with beta blockers for hypertension or for the secondary prevention of myocardial infarction, they benefit as much, if not more, than nondiabetic patients. There may be many circumstances (e.g., hypertensive patients with coronary disease) under which beta blockers are the drugs of first choice for diabetic patients. Recommendations to use agents other than beta blockers (or low dose thiazide diuretics) for the treatment of hypertension in diabetes are based on these agents' effectiveness against surrogate endpoints, and not their proven benefit in preventing important clinical endpoints. Conclusions: Except for patients with brittle glycemic control, manifest hypoglycemic unawareness, renal parenchymal disease, or documented intolerance, beta blockers should no longer be considered routinely contraindicated in the presence of diabetes. hypertensiondiabetes mellitustreatmentbeta bloc Continue reading >>

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