Diabetes Self-Management Blog

Last week, in "The Ups and Downs of Meds and Diabetes (Part 1): Steroids," we took a look at steroids, a powerful class of drugs that, while very good at doing what it’s supposed to do, can cause significant hyperglycemia (high blood glucose). Frequent blood glucose monitoring and using sick-day rules are the best ways to deal with that issue. This week, we’ll look at another category of drugs: hypertension (high blood pressure) medications, since many people with diabetes take these.

There are several classes of hypertension meds, although four of these classes are used most often in diabetes.

ACE Inhibitors: Angiotensin-converting enzyme (ACE) inhibitors are medications that block an enzyme from making angiotensin II. This substance can cause blood vessels to constrict, or narrow, thus raising blood pressure. Common ACE inhibitors include lisinopril (brand names Zestril, Prinivil), enalapril (Vasotec), and captopril (Capoten).

ACE inhibitors are often a first choice for people with diabetes, as they can prevent kidney damage. They also can help people who have heart failure and who have had a heart attack. While these drugs are usually well-tolerated by most people, side effects include dry cough, high potassium levels, dizziness, drowsiness, headache, and altered taste. ACE inhibitors have little effect on blood glucose levels. However, your health-care provider needs to monitor your potassium levels to make sure they stay in a safe range.

ARBs: Angiotensin-II receptor blockers (ARBs, for short) work in a manner similar to ACE inhibitors. They may be prescribed for someone who doesn’t tolerate ACE inhibitors, as they produce less of a cough. ARBs may also provide more protection for the kidneys. Commonly prescribed ARBs include candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan). Side effects are pretty much the same as with ACE inhibitors, with the exception of coughing. Again, potassium levels need to be monitored while taking an ARB.

Beta-Blockers: Beta-blockers (beta-adrenergic blocking agents) lower blood pressure by blocking the effects of epinephrine, or adrenaline. Because they do so, the heart beats more slowly and less forcefully, which, in turn, lowers blood pressure. Beta-blockers also cause blood vessels to relax, which improves blood flow.

While beta-blockers lower blood pressure, they’re also used to treat or improve other conditions, such as arrhythmias, heart failure, heart attack, angina, migraines, glaucoma, and even anxiety. Commonly prescribed beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), propranolol (Inderal), and nadolol (Corgard). Fatigue, cold hands and feet, dizziness, weakness, insomnia, weight gain, shortness of breath, and slow heartbeat are typical side effects.

People with asthma should probably not use beta-blockers, as they can exacerbate symptoms. Beta-blockers may increase triglyceride levels and lower HDL (good) cholesterol.

Also, beta-blockers should be used with caution in people with diabetes. These medications may mask, or hide, the symptoms of low blood glucose. And this is a concern if you take insulin or certain types of diabetes pills that can cause hypoglycemia. If you take a beta-blocker, make sure you check your blood glucose levels frequently, especially if you’re at risk for hypoglycemia.

Calcium Channel Blockers: Calcium channel blockers (CCBs) work to block calcium from entering the cells of the heart and blood vessels. This action helps to lower blood pressure. These medications are also used to treat angina, arrhythmias, and migraines. Nifedipine (Adalat, Procardia), verapamil (Calan, Covera), and amlodipine (Norvasc, Lotrel) are common calcium channel blockers. Side effects include constipation, edema, headache, rapid heartbeat, drowsiness, and rash. Some CCBs shouldn’t be taken with grapefruit juice, as the juice may block the liver from excreting the medication. CCBs may interact with metformin, rosiglitazone (Avandia), and pioglitazone (Actos), so talk to your health-care provider or pharmacist if you take any of these drugs for your diabetes.

Diuretics: Diuretics, often called “water pills,” work to lower blood pressure by causing the body to flush out extra fluid and sodium. There are several kinds of diuretics and they all work somewhat differently. Furosemide (Lasix), bumetanide (Bumex), spironolactone (Aldactone), and hydrochlorothiazide (Esidrix) are common types of diuretics. Side effects include increased urination, fatigue, weakness, dizziness, impotence, increased triglycerides, and, with some diuretics, decreased potassium levels. High doses of diuretics may lead to increased blood glucose levels—again, blood glucose monitoring is important if you take diuretics.

Next week: Lipid-lowering medications.


  1. There are no comments at this time.

Post a Comment

Note: All comments are moderated and there may be a delay in the publication of your comment. Please be on-topic and appropriate. Do not disclose personal information. Be respectful of other posters. Only post information that is correct and true to your knowledge. When referencing information that is not based on personal experience, please provide links to your sources. All commenters are considered to be nonmedical professionals unless explicitly stated otherwise. Promotion of your own or someone else's business or competing site is not allowed: Sharing links to sites that are relevant to the topic at hand is permitted, but advertising is not. Once submitted, comments cannot be modified or deleted by their authors. Comments that don't follow the guidelines above may be deleted without warning. Such actions are at the sole discretion of DiabetesSelfManagement.com. Comments are moderated Monday through Friday by the editors of DiabetesSelfManagement.com. The moderators are employees of Madavor Media, LLC., and do not report any conflicts of interest. A privacy policy setting forth our policies regarding the collection, use, and disclosure of certain information relating to you and your use of this Web site can be found here. For more information, please read our Terms and Conditions.

Oral Medicines
Statins May Reduce Risk of Nerve Damage, Other Diabetes Complications (09/18/14)
New Metformin Combo Drug Approved for Type 2 Diabetes (08/13/14)
FDA Approves New Oral Drug for Type 2 Diabetes (08/07/14)
New SGLT Drugs Coming (07/23/14)

Heart Health
Self-Manage Your Blood Pressure (09/02/14)
Pistachios Offer Protection for People With Diabetes (08/29/14)
Which Butter (or Spread) Is Better? (07/28/14)
High-Salt Diet Doubles Heart Risk in Type 2 Diabetes (07/25/14)

General Diabetes & Health Issues
Getting to Sleep and Staying There (09/24/14)
How Much Do You Know About Diabetes? Six Facts to Get You Thinking (08/25/14)
Doing Your Own Research (08/06/14)
Ensuring a Successful Hospital Stay (08/15/14)



Disclaimer of Medical Advice: You understand that the blog posts and comments to such blog posts (whether posted by us, our agents or bloggers, or by users) do not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs. The opinions and other information contained in the blog posts and comments do not reflect the opinions or positions of the Site Proprietor.