From the Guidelines
Furosemide can be used in patients with hyperglycemia, but it should be done with caution, as it is not specifically indicated for hyperglycemia management and may worsen glucose control. This loop diuretic is primarily used for treating fluid overload and edema. When administering furosemide to hyperglycemic patients, typical dosing ranges from 20-80 mg orally or intravenously, depending on the clinical situation and severity of fluid overload 1. It's essential to monitor blood glucose levels closely when using furosemide in hyperglycemic patients because it can potentially worsen glucose control. Furosemide can cause electrolyte imbalances, particularly hypokalemia, which may affect insulin secretion and glucose metabolism.
Some key considerations when using furosemide in hyperglycemic patients include:
- Monitoring blood glucose levels closely to avoid worsening glucose control
- Regular monitoring of electrolytes (especially potassium) and renal function
- Potential need for dosage adjustments in patients with diabetic nephropathy due to altered drug clearance
- Weighing the benefits of managing fluid overload against the potential risks of worsening glycemic control
According to the most recent guidelines, the management of hyperglycemia in the hospital setting should prioritize insulin therapy, with continuous insulin infusion being the therapy of choice during hyperglycemic crises and critical illness 1. However, in the context of using furosemide, the focus should be on careful monitoring and management of potential interactions between furosemide and glucose control, rather than relying on furosemide as a treatment for hyperglycemia.
From the FDA Drug Label
Increases in blood glucose and alterations in glucose tolerance tests (with abnormalities of the fasting and 2-hour postprandial sugar) have been observed, and rarely, precipitation of diabetes mellitus has been reported Patients with diabetes mellitus should be told that furosemide may increase blood glucose levels and thereby affect urine glucose tests Urine and blood glucose should be checked periodically in diabetics receiving furosemide, even in those suspected of latent diabetes. Hyperglycemia
Furosemide can be used in patients with hyperglycemia, but with caution.
- Monitoring of blood glucose levels is necessary to avoid worsening of hyperglycemia.
- Adjustments in diabetes treatment may be required.
- Regular checks of urine and blood glucose are recommended, especially in patients with diabetes mellitus or those suspected of latent diabetes 2, 3.
- Hyperglycemia is a potential adverse reaction of furosemide therapy 2.
From the Research
Furosemide and Hyperglycemia
- Furosemide can cause hyperglycemia in patients, as evidenced by studies in mice and humans 4, 5, 6.
- The mechanism of furosemide-induced hyperglycemia is thought to be related to its effects on carbohydrate metabolism, including reduced insulin secretion and impaired glucose tolerance 4, 5.
- Furosemide has been shown to inhibit the activity of key glycolytic enzymes, including hexokinase, phosphofructokinase, and pyruvate kinase, which may contribute to its diabetogenic effects 5.
Clinical Implications
- Diabetic patients may require higher doses of furosemide to achieve the same diuretic effect as non-diabetic patients, as suggested by a study of heart failure patients 7.
- The use of furosemide in patients with hyperglycemia should be carefully monitored, as it may exacerbate glucose intolerance and worsen glycemic control 8, 6.
- Maintenance of body potassium levels may help prevent the glucose intolerance associated with thiazide diuretics, but its effect on furosemide-induced hyperglycemia is unclear 8.
Age-Dependent Effects
- Furosemide treatment has been shown to cause age-dependent glucose intolerance and islet damage in obese-hyperglycemic mice, with older mice being more susceptible to its diabetogenic effects 6.
- The clinical implications of these findings are unclear, but they suggest that older patients may be more vulnerable to the hyperglycemic effects of furosemide 6.