After an organ transplant I was given prednisone to prevent rejection.
It made me diabetic. After it was withdrawn, the diabetes also went
away. Now I am taking a diuretic for hypertension and it is raising my
BSL to the 120s. Labetalol seemed to do the same thing, though maybe
not as badly.

My Dr. prescribed Lantus, but it doesn't seem to help much, even at 35
units. Should I be concerned about the higher BSL? Is it more
dangerous than the hypertension? What should I ask the doctor when I
next see him>

1. First question is how high your blood sugar goes during the day.
120 is it fasting or 2 hours after the meal? You may ask your doctor
to order HbA1c blood test which reflects how high your blood sugar was
overall during the last 3 months (the test is accurate unless you have
significantly impaired renal function measured by high creatinine, or
have significant anemia).

2. The higher the blood sugar or blood pressure the more significant
their damaging effect is. Blood sugar even in 120s over prolonged
period of time can be damaging.  The good news is that nowadays you
don't have to choose between safe treatments for hypertension and
diabetes (or pre-diabetes). Actually, there are some blood pressure
medications which were shown to decrease risk of developing diabetes.

Fasting tends to be @ 111. After meals has always been weird. After
one hour it is lower than normal, @140, after two hours @160, but then
comes down very slowly and is in the 125 range after three hours.

You say there are several BP meds that decrease the risk of developing
diabetes. Could you please tell me their names so I can discuss them
with my doctor? I am currently taking Hydrochlorothiazide and
Labetalol.

Thanks very much.

The most effective way of decreasing risk of development of diabetes
is intensive lifestyle modifications with increase in physical
activity and weight loss. These measures are also helpful in lowering
BP.

Of pharmacological interventions that reduce BP and risk of
development of diabetes at the same time, there are drugs like
ramipril, losartan, or carvedilol. The data is stronger for the first
two drugs. You have to understand that the protection from diabetes
they provide is not 100%. Some people may have contraindications to
these medications and, therefore, our discussion here CANNOT
substitute individualized advice provided by your physician.

Thank you very much. I will discuss those drugs with my doctor. I
forgot to mention that my organ transplant was a liver and the people
at the liver clinic do not want me taking any drugs that put
additional loads on the new liver. But, as I understand it, virtually
everything gets processed in the liver, this makes it very difficult.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart
Attack Trial (ALLHAT) was made by National Health Institute to answer
some questions about hypertension treatment. So far, the only studies
were from drug corporations. Ramipril and Losartan, previously cited
by endodoc-ga are similar to lisinopril, wich was tested in allhat. I
think it?s important to say that the ?strong data? for the cited durg
are from corporations.

Conclusions from ALLHAT:

?ALLHAT confirmed results from previous studies regarding biochemical
effects of chlorthalidone (diuretic) compared to amlodipine and
lisinopril. The chlorthalidone group had more hypokalemia (lower
potassium levels), slightly higher mean serum cholesterol and glucose
levels, and slightly higher incidence of new cases of diabetes at four
years follow-up.

The lisinopril group had significantly higher risk of stroke (15%),
heart failure (19%), and angina (11%) compared to the chlorthalidone
group. Increased rate of combined CVD was 10 percent. Results were
consistent across subgroups by gender and diabetic status.?

These results exemplifies that diuretic, in spite of increasing the
incidence of diabetes and cholesterol, reduces the deaths!

This is just a brif example of the superiority of diuretics in
hypertension. One of my colleague says: "If diuretics were a new drug,
they would be very easy to promote". The facts for public could be
seen in: http://www.nhlbi.nih.gov/health/allhat/facts.htm