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.

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  1. John

    I am a 62 yo man who has hypertension for the last 20 years and have been controlled by medication. A year ago I developed Diabetes 2 and my A1C was 7.1. The gave me Metformin and had almost every side effect that was listed.

    I then asked my PCP if I could try diet changes to control my Diabetes. After 3 months of a correct diet my A1C was at 5.3. My PCP noted my Bp was going up and suggested I add a diuretic to my daily pills. Previously, I had checked my glucose every morning from a fast and would have readings of 100-120. After one week of the diuretic my morning glucose reading went to 180 -200.

    I read the side effects on the BP med’s website and stated “if you have asthma; gout; heart problems (eg, congestive heart failure); liver, gallbladder, or kidney problems; high blood cholesterol or lipid levels; DIABETES; or systemic lupus erythematosus” you should not take this medication.

    I still had the non diuretic medication left over and I am now taking it instead, I continued to check my glucose and in a few days it was back to the 100-120 in the morning. It is good to ask questions.


    very helpful information.

  3. SalJ

    I am the lady referenced above and have a new experience with yet another doctor concerning the prescribing of statins from a cardiologist. When my geriatrician replied, “It depends who you listen to,” perhaps he really meant pharmaceutical reps.
    My 75 y/o husband is preparing for back surgery and needed a complete clearance from all of his doctors by his neurosurgeon before he would perform the two-hour surgery. One of the required releases was from his cardiologist because my husband had a heart attack (no heart damage) 24 years ago. He hadn’t seen his cardiologist since eight years ago except for a routine visit, so new tests were performed.
    We first saw a new and very likeable 40 y/o cardiologist who looked at the new copy of his blood work showing a total cholesterol of 171, triglycerides of 112 and with acceptable ratios for both. For the first time, his blood glucose was slightly elevated at 102, which isn’t unusual for older people, I guess. My husband abandoned his statin two years ago and went the route of exercise and diet control, having lost 25 pounds. His cholesterol never was very high. He has regained some of the weight, however, because his bad back has limited his exercise.
    I could hardly believe my ears when this young cardiologist said, “You really need to get back on a statin like lipitor, because studies have proven that statins save lives in reducing plaque in the arteries,” and then showed us a plastic model of a clogged artery with plaque (and this was before even viewing the results of his echo cardiogram and CT 3-D scan of his heart–all finally revealing no problems). Why a statin? I then asked if statins can’t raise blood glucose and possibly cause diabetes (well knowing that they can), and he calmly said, “Most of our patients are diabetic.” WOW, and I wondered why? The many patients in the waiting room were of all ages and weights, so I wonder just who had diabetes. With several recent and revealing studies, why don’t doctors have the capability to question the false beliefs of their own industry? Patients need to do their own homework. Perhaps some patients might benefit from a statin when absolutely necessary, but the following is a good summary of the problem with statins.
    “Newly published research (8/13/2012) has found that statin drug use leads to accelerated coronary artery and aortic artery calcification, both of which greatly contribute to cardiovascular disease and mortality. The new study comes on top of findings that led the FDA to mandate adding “diabetes risk” to the warning label of statin drugs…Increasingly, it is being demonstrated that inflammation is the real culprit in arterial plaque. As NaturalNews recently reported, regardless of the amount of cholesterol in the blood, inflammation will result in the depositing of cholesterol to repair arteries damaged by inflammation.” Tony Isaacs NaturalNews.
    PEOPLE’S PHARMACY RESPONSE: Here’s a link to the abstract referenced above:
    Some doctors have a difficult time recognizing that statins have their place, but they have not been shown to be beneficial across the board for older people.

  4. JennyB

    I had diabetes for 8 years and my glucose levels were well-managed. I developed high blood pressure and my doctor prescribed HCTZ. Shortly after that and continuing for a year I could not control my glucose levels. I then read an article suggesting that HCTZ may be the cause. I talked my doctor. He changed my medication and within 3 days my glucose levels were back to pre-HCTZ levels.

  5. crandreww

    I applaud anyone who takes charge of their own health by keeping abreast of the actual and potential benefits and risks of any medical treatment, as for that ER physicians comments…probabilities are fine, when you are given data which is solid…unlike MANY pharmaceutical “clinical studies” which deal with relative risk reductions versus the Absolute risk reductions…the science becomes muddied and a physician is no longer able to base his/her decisions on solid science…when I had my initial illness, due to Lipitor, initially with profound headaches, confusion, ataxia, apraxia, I was seen in the ER on 3 different occasions, and sent home with a diagnosis of “atypical migraine” which later based on mri scans, Brain Biopsy, revealed neuronal apoptosis (brain cells were killing themselves uncontrollably, because of the lack of Ubiquinol aka CoQ10, which is responsible for controlling apoptosis.
    I am certain, that of the millions of people who take statin drugs, I cannot be the only one this happened to, but it was nowhere in the medical literature…until I met Dr Golomb and her statin effects study, which revealed to me several other people with very similar conditions after being prescribed a statin. How come Pfizer, Glaxo, Astra Zenica, etc etc did not publish these potential risks? I can only assume MONEY, MONEY, MONEY…Statin drugs work on the mevolonate pathway, by blocking an initial step, Acetyl Co A reductace Inhibitor, which will block the other almost 200 steps in this pathway, including CoQ10, Vit D, Steroid Hormones, Dolichols, etc,etc and so on….why are physicians not privy to the ACTUAL risks vs benefits, so THEY can determine a patients treatment…based on HARD SCIENCE vs Checkbook science?

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