FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DIURETICS MIGHT HAVE CONTRIBUTED TO READER'S DIABETES

Question: About three years ago my doctor started me on a water pill for my blood pressure. Shortly afterwards I began to crave candy and Coke - the drink, not the drug. When I went back to my doctor he told me that I had developed diabetes. I have never had any diabetes until I started taking the water pill, nor have any of my relatives. Am I really diabetic, or did the water pill mess up my blood sugar?

Answer: Diuretics have been used for several decades to treat high blood pressure. They are quite effective, but they - like all medications - can have side effects. The most common side effect of diuretics, particularly the most commonly prescribed one called hydrochlorothiazide, is the loss of the essential mineral potassium. Low potassium can cause muscle cramps, and in more extreme cases, irregular heart beats. Another common side effect is

elevation of blood sugar, or as your doctor may have put it, "mild diabetes." Only a small number of those taking diuretics develop this problem, so it isn't fair to say that it causes the disease. However, it may make diabetes apparent in those who are already prone to it because of heredity, illness or diet.

Diabetes is a condition where the body is unable to properly use sugar to fuel the inner workings of each cell. Your habit of eating lots of candy and drinking Coke supplies large amounts of sugar to the body. In many adults this is all it takes to overload a weakened ability to utilize this fuel properly and bring on a condition known as adult onset diabetes.

It is impossible for me to say how much of your problem has arisen from your habits of eating sugar frequently, from illness, or from the diuretic you take for blood pressure. Apparently your doctor feels the benefits of the diuretic in helping to control your blood pressure outweigh the risks; and, therefore, he feels it would not be a good idea to substitute other medications which don't increase blood sugar for the diuretic.

Answer: I don't think I would use the term "worry" to describe an appropriate concern for your health. Diabetes is never a trivial illness, so you should make efforts to control your blood sugar. Often it only requires eating a low-sugar diet to bring the blood sugar down within the normal range. I imagine that your doctor talked to you about eliminating the candy and sugar-based soft drinks from your diet to help control your diabetes. If you have

reduced your sugar intake in this way and your blood sugars are now normal, then I agree with your doctor. Only worry enough about your diabetes to stay away from sugar and to get regular check-ups, including yearly eye examinations.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.