Are there any specific diuretics that are suitable for the treatment of hypertension that are not prone to raising glucose or increasing insulin resistance? I have been using an ARB (anigotensin II receptor blocker) plus HCTZ, (hydrochlorthiazide, a diuretic), 12.5 mg, and am concerned about the potential insulin impacts of thiazides. If the answer is that all diuretics have this potential, are there any specific diuretics and doses that have less of this negative affect?

The usual diuretics cause loss of fluid through the urine and usually cause potassium to be lost with the fluid. The potassium turns out to be important in maintaining the body’s response to insulin. In addition, there is a concern that thiazide diuretics may also cause lipid increases at higher doses. Therefore, when we use diuretics in patients with type 2 diabetes, we are using small doses that do not exceed 25 mg per day. More potent diuretics cause more potassium loss. There is a type of diuretic that is not associated with potassium loss, called spironolactone. However, it is not effective in treating hypertension.

JTL