Metabolism diabetes mellitus, diuretics

Loop and thiazide diuretics may also impair glucose and lipid metabolism, and it has been suggested that high doses of these agents may predispose some patients to type 2 diabetes mellitus.1,13 Although the exact risk of such metabolic disturbances is not known, the long-term use of these drugs has been questioned.67 Nonetheless, concerns about metabolic side effects can be minimized if low doses are administered.13... 

Amiloride is used with thiazide or loop diuretics in hypertension, in congestive heart failure, in digitalis-induced hypokalemia, and in arrhythmias resulting from hypokalemia. Inappropriate use of amiloride may cause hyperkalemia (potassium >5.5 mEq/L), which may be fatal if not corrected, and may be more deleterious in elderly individuals and in patients with diabetes mellitus and renal impairment. The symptoms of hyperkalemia include fatigue, flaccid paralysis of the extremities, paresthesias, bradycardia, ECG abnormalities, and shock. Amiloride is not metabolized but is contraindicated in anuria, acute or chronic renal insufficiency, or in diabetic nephropathy. It should not be used with potassium preparations, and should be used cautiously with ACE inhibitors because these agents cause hyperkalemia. 

Amiloride (Midamor) Directly increases Na+ excretion and decreases K+ secretion in distal convoluted tubule. Used with other diuretics because K+-sparing effects lessen hypokalemic effects. May correct metabolic alkalosis. HYPERkalemia, sodium or water depletion. Patients with diabetes mellitus may develop glucose intolerance. 

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