Q. My husband was prescribed HCTZ (hydrochlorothiazide) for high blood pressure. At the same time, his blood sugar was tested (HbA1C) and we were told that he was “not diabetic”.
Four months later, he ended up in the emergency room with low potassium and his blood sugar was again tested and he “was not diabetic.” Two months after that (6 months on HCTZ), he was in the ER again, this time with diabetic ketoacidosis (DKA). He was in intensive care for 5 days with insulin therapy, during which time I did more intensive research myself. The Doctor refused to acknowledge that the problem was caused by the HCTZ, and insisted that he was an “undiagnosed diabetic,” even though the prior hospital testing proved otherwise.
Doctors wanted him back on the HCTZ when discharged, and we refused. Came home from hospital and the next day we were back at the Doctors office due to a bad reaction to the insulin.
After getting off the hydrochlorothiazide completely he was able to stop all diabetes medication. The doctor still insists that he is diabetic, even though his most recent HbA1C rest results came back: “not diabetic.”
A. It is quite surprising to us that your husband’s physicians had such a hard time acknowledging that the diuretic HCTZ (hydrochlorothiazide) could have raised his blood sugar levels high enough to trigger a diagnosis or diabetes. This is a well-known adverse reaction to a great many diuretics such as:
• Bendroflumethiazide (Naturetin)
• Benzthiazide (Exna)
• Bumetanide (Bumex)
• Chlorothiazide (Diuril, Diachlor, Diurigen)
• Chlorthalidone (Hygroton)
• Ethacrynic acid (Edecrin)
• Furosemide (Lasix)
• Hydrochlorothiazide (Esidrix, HydroDIURIL, Oretic)
• Hydroflumethiazide (Diucardin)
• Methyclothiazide (Aquatensen, Enduron)
• Polythiazide (Renese)
• Trichlormethiazide (Diurese, Metahydrin, Naqua)
HCTZ (also abbreviated HCT) is often found in other popular blood pressure medications such as:
All the medications listed above have the potential to raise blood sugar and in some susceptible individuals may even trigger frank diabetes.
It is totally surprising that the doctors described your husband’s situation as “undiagnosed diabetes.” The FDA requires the following language in the official prescribing information:
“In diabetic patients dosage adjustments of insulin or oral hypoglycemic [diabetes] agents may be required. Hyperglycemia [diabetes] may occur with thiazide diuretics. Thus latent diabetes mellitus may become manifest during thiazide therapy.”
In truth there are a lot of unresolved questions about the blood sugar elevations brought on by drugs. The FDA seems to be blaming the patient by suggesting that “latent” diabetes or “undiagnosed diabetes” exists before the drug is given. The assumption seems to be that diabetes, though undiagnosed, is a pre-existing condition. Other researchers have suggested that low potassium levels, brought on by these drugs might also be a contributing factor. There is also evidence that these diuretics decrease the amount of insulin released by the pancreas.
Regardless of the mechanism, there is little doubt that such drugs can precipitate diabetes. What is not clear is if a person like your husband never received a diuretic like HCTZ whether he would develop diabetes anyway.
Symptoms of diabetic ketoacidosis include:
• Great thirst
• Frequent urination
• Weakness, exhaustion, fatigue
• Digestive distress (stomach pain, nausea, vomiting)
• Difficulty catching your breath, fruity smelling breath
This is a potentially life-threatening situation and required immediate medical attention!
There are dozens of other types of medications that can trigger elevated blood sugar or even diabetes. Just a few examples include:
• Leuprolide (Lupron)
• Statins (atorvastatin, lovastatin, rosuvastatin, simvastatin, etc.)
• Tacrolimus (Prograf)
If you would like to learn more about drugs that can raise blood sugar levels we suggest our brand new Guide to Managing Diabetes. In addition to a list of drugs, you will find insights into the best diet for diabetes, a variety of non-drug approaches including herbs and spices for better blood sugar control (including cinnamon).
Even if you do not have diabetes, we think this new guide will provide valuable information about healthy eating habits for everyone. Diabetes and pre-diabetes have become epidemic in America. We hope our new guide will be helpful in helping people make informed choices to prevent or better deal with this condition. Here is a link to the guide.