ACE INHIBITORS & diabetes

On Fri, 10 Oct 2003 20:13:22 -0400 (EDT), [email hidden]

(*K~A~N~D~E~E*) said:

i've just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc
says that i have a moderate level on Protein in my urine & that that drug is to PROTECT my kidneys.
anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about side
effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that Enalapril
in small doses,like ine will help me.

i am not sure if there are formal studies are not, but the anecdotal evidence that ACE (angiotensis
converting enzyme) inhibitors protect the kidney from further damage and may improve kidney function
in diabetic patients with protein in the urine is so widespread that I don't think anyone seriously
questions it.

If memory serves me right, in article <[email hidden]>,

*K~A~N~D~E~E* said:

anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about side
effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that
Enalapril in small doses,like ine will help me.

This is commonly prescribed, even for diabetics who don't show any protein in their urine. The ACE
inhibitors lower blood pressure, so if you have low blood pressure already that may be a concern.
The other major side effect I'm aware of is that some people develop a dry cough. Other than that,
there doesn't seem to be much of a downside and the benefit is substantial, I'm told.

Vance Kochenderfer | "Get me out of these ropes and into a [email hidden] | good belt of Scotch"
-Nick Danger

*K~A~N~D~E~E* wrote in message <[email hidden]>... i've
just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc says
that i have a moderate level on Protein in my urine & that that drug is to PROTECT my kidneys.
anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about side effects?
ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that Enalapril in small
doses,like ine will help me.

ACE inhibitors such as Enalapril have displayed outstanding results in clinical trials with
diabetics. They reduce premature heart attack risk, fight kidney failure, and are even thought to
have some beneficial effects on Type 2 diabetic blood sugars.

The major troublesome side effect of ACE inhibitors such as Enalapril is a dry cough. I fought one
for a year before giving up and asking for an ARB. The ARB inhbitors are thought to be as good or
perhaps better than ACE but they cost much more.

For serious** cases, many docs are prescribing both an ACE and an ARB simultaneously!

(**serious as in "what the Type 2 diabetic doctor prescribes for himself!"😉

A "moderate level of protein" is "too d*mn much!". That is a clear call for you to get really
serious about blood sugar control. Many diabetics work hard to minimize the number of pills they
have to take, or to minimize the medicines they have to use. However, when their kidneys start
passing protein, it's time to get really serious about optimizing their med packages. It's also a
good time to review low carb diets and improved exercise plans!

Regards
Old Al

I'm on 5mg of Altace, which is an ACE inhibitor. I was not showing any protein in my urine, but was
put on it because my blood pressure was constantly 120ish over 80. My endo was not happy with the
80. He mentioned at the time that evidnce showed that the ACE inhibitors protect the kidneys in
addition to lowering the blood pressure. I have not noticed any side effects. Steph

"*K~A~N~D~E~E*" <[email hidden]> wrote in message news:21751-3F874B22-47@storefull-
2118.public.lawson.webtv.net...

Quoted message said:

i've just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc
says that i have a moderate level on Protein in my urine & that that drug is to PROTECT my
kidneys. anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about
side effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that
Enalapril in small doses,like ine will help me.

Quoted message said:

Subject: ACE INHIBITORS & diabetes
From: [email hidden] (*K~A~N~D~E~E*)
Date: 10/10/2003 6:13 PM Mountain Daylight Time
Message-id: <[email hidden]>

Since they have shown iron / elevated iron levels to be very common in diabetes .. and since they
have recommended iron reduction therapy for over fifty percent of diabetics .. the fact ACE
inhibitors are in fact .. iron binders .. might be of interest ..?

Rev Port Cardiol. 1992 May;11(5):425-30. Related Articles, Links

[Angiotensin-converting enzyme inhibitors as neutralizers of hydroxyl radical]

[Article in Portuguese]

Mira ML, Silva MM, Queiros MJ, Manso C.

Instituto de Quimica Fisiologica. Faculdade de Medicina de Lisboa.

Angiotensin converting enzyme inhibitors are utilized in the treatment of essential hypertension and
of chronic cardiac failure. They are also employed in the treatment of the myocardial lesion of ischemia-
reperfusion, which involves oxygen free radicals. In the present study we investigated the
possibility of three angiotensin converting enzyme inhibitors (captopril, enalapril, lisinopril) to
act as hydroxyl radical scavengers. The rate constants for reactions of those compounds with .OH
were determined using the deoxyribose method. All three compounds proved to be good scavengers of
.OH with rate constants of about 10(10)M-1s-1 and are iron chelators specially enalapril. The fact
that captopril possesses a thiol group does not confer an higher antioxidative capacity. These
results suggest that scavenging of oxygen free radicals may be a possible mechanism contributing to
the therapeutic effect of angiotensin converting enzyme inhibitors.

PMID: 1325814 [PubMed - indexed for MEDLINE]

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A few years ago I started taking 1.25mg of Ramipril, an ACE inhibitor (in Australia) to reduce an
elevated blood pressure - I actually recommended that to my doctor after reading about ACE
inhibitors on this newsgroup. A few months later I had it increased to 2.5mg a day. Then to 5. Early
this year I saw an endo who recommended I up that to 10mg per day capsule. I've never had any side
effects, not even the possible dry cough. I keep on reading that ACE inhibitors protect your
kidneys. I have been told that some endos routinely prescribe them for diabetics, even those with no
blood pressure problem.

Henry

"*K~A~N~D~E~E*" <[email hidden]> wrote in message news:21751-3F874B22-47@storefull-
2118.public.lawson.webtv.net...

Quoted message said:

i've just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc
says that i have a moderate level on Protein in my urine & that that drug is to PROTECT my
kidneys. anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about
side effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that
Enalapril in small doses,like ine will help me.

In article <[email hidden]>,

*K~A~N~D~E~E* said:

i've just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc
says that i have a moderate level on Protein in my urine & that that drug is to PROTECT my kidneys.
anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about side
effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that Enalapril
in small doses,like ine will help me.

I have been taking this for years to help control blood pressure. My dose is 20 mg at a time,
twice daily.

There are side effects, but as usual, YMMV. I have no significant problems.

--
This address is for information only. I do not claim that these views are those of the Statistics
Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University
[email hidden] Phone: (765)494-6054 FAX: (765)494-0558

In article <[email hidden]>,

hemyd said:

A few years ago I started taking 1.25mg of Ramipril, an ACE inhibitor (in Australia) to reduce an
elevated blood pressure - I actually recommended that to my doctor after reading about ACE
inhibitors on this newsgroup. A few months later I had it increased to 2.5mg a day. Then to 5.
Early this year I saw an endo who recommended I up that to 10mg per day capsule. I've never had
any side effects, not even the possible dry cough. I keep on reading that ACE inhibitors protect
your kidneys. I have been told that some endos routinely prescribe them for diabetics, even those
with no blood pressure problem.

It's trickled down to GPs, at least to mine. She said on my last visit that an ACE or an ARB would
be automatic for any Type2s on meds and it's at least discussed for those on no meds; her only
concern is potential side-effects (coughs and the like). So, we're thinking about it and will
discuss it some more on my next visit; there are some thyroid potential issues that take higher
priority, and she knows that I hate the idea of *any* meds, but we'll still talk about it.

--
AF "Non Sequitur U has a really, really lousy debate team." --artyw raises the bar on
rec.sport.baseball

doe said:

Quoted message said:

Subject: ACE INHIBITORS & diabetes From: [email hidden] (*K~A~N~D~E~E*) Date: 10/10/2003
6:13 PM Mountain Daylight Time Message-id: <21751-3F874B22-47@storefull-
2118.public.lawson.webtv.net>

Since they have shown iron / elevated iron levels to be very common in diabetes .. and since they
have recommended iron reduction therapy for over fifty percent of diabetics .. the fact ACE
inhibitors are in fact .. iron binders .. might be of interest ..?

The only "they" in this statement is you and your anti-meat whackjobs, Doe. You're almost as bad as
Betty Martini and aspartame....

doe said:

Quoted message said:

Subject: ACE INHIBITORS & diabetes From: [email hidden] (*K~A~N~D~E~E*) Date: 10/10/2003
6:13 PM Mountain Daylight Time Message-id: <21751-3F874B22-47@storefull-
2118.public.lawson.webtv.net>

Since they have shown iron / elevated iron levels to be very common in diabetes .. and since they
have recommended iron reduction therapy for over fifty percent of diabetics .. the fact ACE
inhibitors are in fact .. iron binders .. might be of interest ..?

The only "they" in this statement is you and your anti-meat whackjobs, Doe. You're almost as bad as
Betty Martini and aspartame....

Herman Rubin said:

In article <[email hidden]>, *K~A~N~D~E~E*

Quoted message said:

i've just been prsescribed one by my doc. i'm taking 5mg of ENALAPRIL MALEATE once a day. my doc
says that i have a moderate level on Protein in my urine & that that drug is to PROTECT my
kidneys. anyone here have any ideas about this? Or anyone here ever taken ENALAPRIL? what about
side effects? ive NEVER been on any Heart meds (well,just Lipitor,if that counts). i read that
Enalapril in small doses,like ine will help me.

I have been taking this for years to help control blood pressure. My dose is 20 mg at a time,
twice daily.

There are side effects, but as usual, YMMV. I have no significant problems.

A lot of folks are taking Lisinopryl instead these days: similar effects, similar dosages, much
cheaper drug....

(doe) said:

Quoted message said:

Subject: ACE INHIBITORS & diabetes From: [email hidden] (*K~A~N~D~E~E*) Date: 10/10/2003
6:13 PM Mountain Daylight Time Message-id: <21751-3F874B22-47@storefull-
2118.public.lawson.webtv.net>

Since they have shown iron / elevated iron levels to be very common in diabetes

that is not a true statement.

Quoted message said:

.. and since they have recommended iron reduction therapy for over fifty percent of diabetics ..

another false statement.

Mack Type 1 since 1975 alt-support-diabetes.orgalt-support-diabetes.orgOpen ↗ insulin-pumpers.orginsulin-pumpers.orgOpen ↗

In tribute to the United States of America and the State of Israel, two bastions of strength in a
world filled with strife and terrorism.

"Alice Faber" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

In article <[email hidden]>, "hemyd"

Quoted message said:

A few years ago I started taking 1.25mg of Ramipril, an ACE inhibitor

(in

Quoted message said:

Quoted message said:

Australia) to reduce an elevated blood pressure - I actually recommended that to my doctor after
reading about ACE inhibitors on this newsgroup.

A

Quoted message said:

Quoted message said:

few months later I had it increased to 2.5mg a day. Then to 5. Early

this

Quoted message said:

Quoted message said:

year I saw an endo who recommended I up that to 10mg per day capsule.

I've

Quoted message said:

Quoted message said:

never had any side effects, not even the possible dry cough. I keep on reading that ACE
inhibitors protect your kidneys. I have been told that

some

Quoted message said:

Quoted message said:

endos routinely prescribe them for diabetics, even those with no blood pressure problem.

It's trickled down to GPs, at least to mine. She said on my last visit that an ACE or an ARB would
be automatic for any Type2s on meds and it's at least discussed for those on no meds; her only
concern is potential side-effects (coughs and the like). So, we're thinking about it and will
discuss it some more on my next visit; there are some thyroid potential issues that take higher
priority, and she knows that I hate the idea of *any* meds, but we'll still talk about it.

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace inhibitors is actually, very small. Jan

Quoted message said:

--
AF "Non Sequitur U has a really, really lousy debate team." --artyw raises the bar on
rec.sport.baseball

Jan Devers wrote in message ...
. . .(snip). . .

Quoted message said:

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace inhibitors is actually, very small. Jan

". . .The risk of acquiring a cough as a side-effect of ace inhibitors is actually, very small. " .
. . and speaking as one who suffered the cough side effect, it was somewhat annoying but otherwise
an "almost trivial" effect; one not to be afraid of or otherwise consider when chosing meds.

I fiddled with anti-cough techniques for a whole year (split dose, cough suppressants, etc) before
finally asking for another med, a decision helped along when I read that ARB were starting to look
pretty good.

Regards
Old Al

Jan Devers said:

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace inhibitors is actually, very small. Jan

That is probably true. However you should find out what the estimated risk is in your case. Some of
the statistics given by drug salesdroids are somewhat misleading.

Take this hypothetical example.

Suppose your risk of mortality is actually 3%/year, which is pretty high. Suppose you reduce you
risk of mortality by 30% that risk becomes 2.1%, a significant reduction. Now suppose that the risk
of permanent serious side effects, is 1%. That presents a significant risk/benift ratio.

I just started taking statins and went through this. Some the side effects there are on this order
of magnitude and some like liver damage are quite serious but fairly rare.

I'm suggesting that we need think seriously about this. My Doctor had a computer program which
estimated the risks of various outcomes, and the impact of some of the meds. It was pretty
enlightening. I don't know what the program was and didn't think to ask. I'm going to get more
information. It seems with all of the information availible it should be possible to make some
projections along these lines to see if the meds are truly helpful.

--
K'neH'a'Iw

Uncloaking, Shields up.

Jan Devers said:

"Alice Faber" <[email hidden]> wrote in message news:afaber-
[email hidden]...

Quoted message said:

In article <[email hidden]>, "hemyd"

Quoted message said:

A few years ago I started taking 1.25mg of Ramipril, an ACE inhibitor

(in

Quoted message said:

Quoted message said:

Australia) to reduce an elevated blood pressure - I actually recommended that to my doctor
after reading about ACE inhibitors on this newsgroup.

A

Quoted message said:

Quoted message said:

few months later I had it increased to 2.5mg a day. Then to 5. Early

this

Quoted message said:

Quoted message said:

year I saw an endo who recommended I up that to 10mg per day capsule.

I've

Quoted message said:

Quoted message said:

never had any side effects, not even the possible dry cough. I keep on reading that ACE
inhibitors protect your kidneys. I have been told that

some

Quoted message said:

Quoted message said:

endos routinely prescribe them for diabetics, even those with no blood pressure problem.

It's trickled down to GPs, at least to mine. She said on my last visit that an ACE or an ARB
would be automatic for any Type2s on meds and it's at least discussed for those on no meds; her
only concern is potential side-effects (coughs and the like). So, we're thinking about it and
will discuss it some more on my next visit; there are some thyroid potential issues that take
higher priority, and she knows that I hate the idea of *any* meds, but we'll still talk about it.

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace inhibitors is actually, very small. Jan

That's what the literature says. Talk to any Dr. Prescribing it, and most are convinced the real
number is ulitmately about 30%.

"oldal4865" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Jan Devers wrote in message ...
. . .(snip). . .

Quoted message said:

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace

inhibitors

Quoted message said:

Quoted message said:

is actually, very small. Jan

". . .The risk of acquiring a cough as a side-effect of ace inhibitors is actually, very small.
" . . . and speaking as one who suffered the cough side effect, it was somewhat annoying but
otherwise an "almost trivial" effect; one not to be afraid of or otherwise consider when
chosing meds.

I fiddled with anti-cough techniques for a whole year (split dose, cough suppressants, etc) before
finally asking for another med, a decision

helped

Quoted message said:

along when I read that ARB were starting to look pretty good.

Regards
Old Al

ARBs sound like a better alternative for you, in any case. I've read that they are beneficial in a
similar vein to ace inhibitors but my doctor seemed to dismiss this. My husband tried tried an ARB
for simple HBP and it did nothing for him, but neither did ace inhibitors which I find the best as
far as efficacy and low probability of side-effects. Jan

"K'neH'a'Iw" <[email hidden]> wrote in message
news:qL_hb.68132$Ms2.9429@fed1read03...

Quoted message said:

Jan Devers said:

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace

inhibitors

Quoted message said:

Quoted message said:

is actually, very small. Jan

That is probably true. However you should find out what the estimated risk

is in your case. Some of the statistics given by drug salesdroids are somewhat misleading.

Quoted message said:

Take this hypothetical example.

Suppose your risk of mortality is actually 3%/year, which is pretty high.

Suppose you reduce you risk of mortality by 30% that risk becomes 2.1%, a significant reduction. Now
suppose that the risk of permanent serious side effects, is 1%. That presents a significant
risk/benift ratio.

Quoted message said:

I just started taking statins and went through this. Some the side effects

there are on this order of magnitude and some like liver damage are quite serious but fairly rare.

Quoted message said:

I'm suggesting that we need think seriously about this. My Doctor had a

computer program which estimated the risks of various outcomes, and the impact of some of the meds.
It was pretty enlightening. I don't know what the program was and didn't think to ask. I'm going to
get more information. It seems with all of the information availible it should be possible to make
some projections along these lines to see if the meds are truly helpful.

Quoted message said:

--
K'neH'a'Iw

Uncloaking, Shields up.

Well, I'm not easy prey to drug salesdroids and am resisting my doctor's pressure to take ramipril
over another ace inhibitor but will look into obtaining the percentages you mention. I think you're
right to have careful monitoring while taking a statin as the possibilities of dangerous side-
effects exist, as you're aware. I think they're touted as being good for a number conditions. Jan

"matt weber" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Jan Devers said:

"Alice Faber" <[email hidden]> wrote in message news:afaber-
[email hidden]...

Quoted message said:

In article <[email hidden]>, "hemyd" <[email hidden]>
wrote:

> A few years ago I started taking 1.25mg of Ramipril, an ACE inhibitor

(in

Quoted message said:

> Australia) to reduce an elevated blood pressure - I actually

recommended

Quoted message said:

Quoted message said:

Quoted message said:

> that to my doctor after reading about ACE inhibitors on this

newsgroup.

Quoted message said:

Quoted message said:

A

Quoted message said:

> few months later I had it increased to 2.5mg a day. Then to 5. Early

this

Quoted message said:

> year I saw an endo who recommended I up that to 10mg per day capsule.

I've

Quoted message said:

> never had any side effects, not even the possible dry cough. I keep

on

Quoted message said:

Quoted message said:

Quoted message said:

> reading that ACE inhibitors protect your kidneys. I have been told

that

Quoted message said:

Quoted message said:

some

Quoted message said:

> endos routinely prescribe them for diabetics, even those with no

blood

Quoted message said:

Quoted message said:

Quoted message said:

> pressure problem.

It's trickled down to GPs, at least to mine. She said on my last visit that an ACE or an ARB
would be automatic for any Type2s on meds and

it's

Quoted message said:

Quoted message said:

Quoted message said:

at least discussed for those on no meds; her only concern is potential side-effects (coughs and
the like). So, we're thinking about it and

will

Quoted message said:

Quoted message said:

Quoted message said:

discuss it some more on my next visit; there are some thyroid potential issues that take higher
priority, and she knows that I hate the idea of *any* meds, but we'll still talk about it.

My doctor quotes the mortality risk as being lowered by 30% in users of ramipril. The risk of
acquiring a cough as a side-effect of ace

inhibitors

Quoted message said:

Quoted message said:

is actually, very small. Jan

That's what the literature says. Talk to any Dr. Prescribing it, and most are convinced the real
number is ulitmately about 30%.

Even at the 30% figure, I'd think it'd be worth giving them a try. So, if you get a cough go on to
another med. Jan