Tightrope walk between medication pills with stormy sky background representing managing diabetes and hypertension.

Thiazide Diuretics: A Hidden Culprit in Diabetic Ketoacidosis?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"Unveiling the Link Between Common Hypertension Meds and DKA Risk."

Hypertension, affecting over 75 million Americans, is often managed with thiazide diuretics (TDs). These medications are generally considered a first-line treatment, but recent research suggests a potential dark side, especially for those with pre-existing metabolic issues.

A new case report sheds light on a concerning link between thiazide diuretic use and the development of diabetic ketoacidosis (DKA), a dangerous complication of diabetes. While TDs are widely prescribed, their impact on glucose metabolism may be underestimated, particularly in individuals with risk factors.

This article explores the findings of the case report, delving into the possible mechanisms by which thiazide diuretics can induce DKA, and what individuals and healthcare providers should consider to mitigate this risk.

The Case: When a Hypertension Med Triggers DKA

Tightrope walk between medication pills with stormy sky background representing managing diabetes and hypertension.

A 49-year-old man with a history of hypertension, pre-diabetes (HbA1c 6.2%), and obesity was admitted to the hospital for DKA. Prior to admission, he had started hydrochlorothiazide (HCTZ), a thiazide diuretic, as a sole therapy for his hypertension.

Within weeks of starting HCTZ, the patient developed classic DKA symptoms: excessive urination (polyuria), extreme thirst (polydipsia), and increased thirst. His blood glucose was dangerously high (598 mg/dL), and his HbA1c, a measure of long-term blood sugar control, had soared to 11.7%.

The patient's DKA resolved with insulin and fluid replacement.
HCTZ was discontinued and replaced with lisinopril.
His insulin needs rapidly decreased.
His HbA1c improved significantly, reaching 5.1%.
Importantly, he had no further DKA episodes after stopping the thiazide diuretic.
Further testing ruled out other common causes of DKA.

This case highlights how, in susceptible individuals, thiazide diuretics can disrupt glucose metabolism and trigger DKA. The rapid improvement after stopping the medication strongly suggests a direct link.

What Does This Mean for You?

While thiazide diuretics are generally safe and effective for treating hypertension, this case serves as a reminder of potential risks. Individuals with pre-diabetes, diabetes, or metabolic syndrome should be particularly vigilant.

<ul><li>Regular Monitoring: If you're taking a thiazide diuretic, especially if you have risk factors for diabetes, monitor your blood glucose levels regularly.</li><li>Awareness of Symptoms: Be aware of the symptoms of DKA: excessive thirst, frequent urination, nausea, vomiting, abdominal pain, and fatigue. Seek immediate medical attention if you experience these.</li><li>Open Communication: Discuss your concerns and risk factors with your healthcare provider. Explore alternative hypertension treatments if necessary.</li></ul>

This case underscores the importance of personalized medicine and careful consideration of individual risk factors when prescribing medications. By staying informed and proactive, you can minimize your risk and protect your health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.chest.2018.08.242, Alternate LINK

Title: An Interesting Cause Of Diabetic Ketoacidosis: Case Report, Review Of Literature And Possible Pathophysiology Of Thiazide Diuretics-Induced Dka

Subject: Cardiology and Cardiovascular Medicine

Journal: Chest

Publisher: Elsevier BV

Authors: Xian Qiao, Leonard Moses

Published: 2018-10-01

Everything You Need To Know

What are Thiazide Diuretics and how do they relate to this situation?

Thiazide diuretics are medications commonly used to treat hypertension. The case presented involves a 49-year-old man who developed diabetic ketoacidosis (DKA) after starting hydrochlorothiazide (HCTZ), a specific type of thiazide diuretic. DKA is a serious complication of diabetes. His DKA resolved with insulin and fluid replacement after discontinuing the thiazide diuretic. This highlights a potential risk associated with thiazide diuretics for certain individuals.

What exactly is Diabetic Ketoacidosis (DKA)?

Diabetic ketoacidosis (DKA) is a severe and potentially life-threatening complication of diabetes. It occurs when the body doesn't have enough insulin, causing it to break down fats for energy, which leads to a buildup of ketones in the blood. The patient in the case experienced classic DKA symptoms, including excessive urination (polyuria), extreme thirst (polydipsia), and increased thirst. If left untreated, DKA can lead to coma or even death, emphasizing the critical need for prompt diagnosis and treatment.

What is the connection between the thiazide diuretic and the patient's condition?

The case report strongly suggests a link between thiazide diuretics and DKA in susceptible individuals. When the patient stopped taking the hydrochlorothiazide (HCTZ), his condition improved, his insulin needs decreased, and his HbA1c improved significantly, reaching 5.1%. The rapid resolution of DKA after stopping the thiazide diuretic strongly indicates the medication's role in triggering the condition. Further testing ruled out other common causes of DKA.

Who should be most cautious when considering or taking thiazide diuretics?

Individuals with pre-diabetes, diabetes, or metabolic syndrome should be particularly vigilant when taking thiazide diuretics. The case highlights that thiazide diuretics can disrupt glucose metabolism and potentially trigger DKA in susceptible individuals. Healthcare providers should carefully consider the potential risks and benefits of thiazide diuretic use, especially in patients with pre-existing metabolic issues. If you experience symptoms of DKA, such as excessive thirst, frequent urination, or other concerning symptoms, seek immediate medical attention.

What does this case mean for people taking thiazide diuretics and their doctors?

The implications of this case are significant. It suggests that thiazide diuretics, although widely used, may have underappreciated effects on glucose metabolism, particularly in individuals with risk factors. The findings serve as a reminder of the potential risks associated with these medications. It encourages healthcare providers to consider alternative treatments or closely monitor patients, especially those with pre-diabetes, diabetes, or metabolic syndrome, who are prescribed thiazide diuretics. This also highlights the importance of patient education regarding DKA symptoms and the need for prompt medical attention if symptoms arise.