Doctors are faced with a difficult dilemma whenever they prescribe a medication. All drugs may have side effects, so the physician has to weigh the potential of the medicine to help against the possibility it will do harm.
A few weeks ago, we responded to a reader whose husband developed diabetes after six months on the blood pressure pill hydrochlorothiazide (HCT or HCTZ). Diuretics like this are inexpensive and effective for controlling hypertension, so tens of millions of people take them alone or in combination with other blood pressure medicines. In some people, however, diuretics are associated with high blood sugar or even diabetes.
The FDA includes a warning about this possible complication in the official prescribing information, but some doctors are skeptical. One visitor to our web site was upset that we linked diuretics like HCTZ to diabetes: “I have been a board certified internist and emergency room physician for 21 years. Your irresponsible article has doubtless frightened many people completely unnecessarily.
“There’s no such thing as a harmless medication, whether it is herbal or pharmaceutical. As doctors, we deal in probabilities because there are no absolutes. HCTZ will probably not cause diabetes. Weight and other issues are much more likely risk factors. If diabetes develops, it should be managed with a low-carb, low-sodium diet, which is, after all, what the patient should have been consuming before the hypertension diagnosis.”
Doctors often depend on the official prescribing information to learn about drug side effects. But it can take years for some complications to be detected and included in doctors’ reference material.
Such was the case with statin-type cholesterol-lowering drugs like atorvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. Such drugs can raise blood sugar levels and even trigger diabetes in susceptible patients. This came as quite a shock to prescribers.
Patients, however, are learning from their own experience and research that their medicine sometimes causes unexpected reactions.
One woman responded to the doctor’s comment: “I like to be in partnership with my geriatrician, but he does not keep up with recent studies that are easily available. When my blood glucose suddenly became elevated, I showed him recent studies (The Lancet, Archives of Internal Medicine and JAMA) showing that women over age 50 taking statins run a significant risk of developing diabetes. He wouldn’t even read them, saying, ‘It depends who you listen to.’ At the end of our meeting, he said, ‘I do have a medical degree.'”
We applaud patients who are engaged and do their own homework as this woman did. We also appreciate doctors who are open to such conversations. Our brand-new Guide to Managing Diabetes lists many medicines that may raise the risk of high blood sugar and offers ways to manage it. In addition to medications, careful attention to physical activity, diet and many herbs can be very helpful.