Occasionally a patient may develop diabetes after being started on diuretic therapy.


Mechanism: Diuretic therapy can result in secondary hyperaldosteronism (either due to decreased effective blood volume or increased renin activity) with potassium wastage. Adequate levels of potassium are required for adequate insulin secretion. Hypokalemia can result in glucose intolerance.


Clinical features:

(1) onset or worsening of hyperglycemia after starting diuretic therapy

(2) potassium depletion with hypokalemia

(3) reversal of hyperglycemia after potassium replacement, switch to a potassium sparing diuretic, or discontinuation of the diuretic


Additional features that would support the diagnosis:

(1) elevated serum aldosterone during the original diuretic therapy

(2) recurrence of hyperglycemia on restarting the original diuretic therapy


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