Prophylatic Ace Inhibitor

My primary care doctor wants me to start taking an Ace Inhibitor-prophylacticlly. (sorry-that probably wasn’t spelled right!)

It’s not entirely without reason, my a1c’s are still pretty high + my LDL cholesterol is a tad elevated. Though I have no trace of protein spilling, and my blood pressure is excellent he feels its probably just a matter of time before that stuff starts happening. (yes to family history of both heart disease and diabetes)Not a very cheery outlook but he does have a point(my a1c’s suck)

Thoughts? I hate taking more drugs, but maybe I should.

My cholesterol was tad bit elevated and my endo put me on Zocor. I saw her 2 weeks ago and my cholesterol after a month on the Zocor was greatly improved. She also took a urine sample to get a baseline for the eventual use of an Ace Inhibitor. I do know what you mean though I was very reluctant to start taking a cholesterol medication. I feel like an old person with all the meds I am taking. Different colors and shape not to mention it costs alot of money.
My opinion start taking a cholesterol medication first and then worry about the Ace. Also start seeing an Endocrinologist PCP’s are not very good with the diabetes thing in my opinion. If you don’t pump start, your BG will improve.

Absolutely. I started taking an ace inhibitor after I was spilling protein and am firmly convinced that it, along with improved bg control, was responsible for my kidney function returning to normal.
I know that a pill symbolizes a lot of unpleasant things to us, but, you get used to it. Please considerit.

Ace Inhibitors are prescribed for diabetics to prevent kidney damage. They are prescribed before you start to have issues and like Kathy states to improve function of failing kidneys. They are for elevated blood pressure as well and is the reason they are prescribed for kidney function as they dialate the vessels to help things work better in the kidneys.

I have been taking them for about 4 years as I too have started to spill protein, but I have been diabetic for 40 years, so it is expected.

I was also told to start a cholesterol med to lower my LDL and it did big time, but somehow I did not feel right so I stopped them and will see what my LDL is next time. Both my internist and my endo fight with me on this one. Cholesterol meds lower your LDL and also help with inflammation of vessels, which then helps your kidneys and other arteries in your body as well to function better.

I take and ace inhibitor- lisinopril- for high blood pressure. I started on 10 mg and had terrible side effects of low blood pressure and dizziness. After some experimentation, including taking lower doses twice a day, I am now taking 2 1/2 mg once a day and it does the trick for my blood pressure without any nasty side effects. How much does your doctor want you to take? If your blood pressure is already low, you might have a problem with it going too low on an ace inhibitor.

You werent the only one who had alot of problems with it!!! My kidney DR ( can’t even start to spell what he is) put me on the same and told me to take it twice a day @ 10 mg. I was getting really dizzy with in like a week and had to go get my eyes checked for a yearly exam. When I went in there my bp was 74/54! The nurse who took it ask me how I was even talking little along walking. Needless to say after that my endo cut it way down! I know take 1/2 (5mg) at night before I go to bed and am now running 107/62. Thank GOD!!!

I split my dose and took half at night and half in the morning, and that helped, but then I found I was still going too low at times, so I cut back to just 2 1/2 mg once a day. I also found that I had insomnia when I took it at night. Now I take it at 2 PM in the afternoon because it peaks in the evening, when I am not so active. If the peak happens in the morning, and I exercise, I would get dizzy. I am particularly sensitive to any kind of medication, so other people might not be quite so strongly affected. If my BP averages 105/60 it will go too low when I get a lot of exercise, so I prefer to keep it closer to 120/70.

Hey good idea! I am gonna try that this afternoon! Like you it causes me insomona so another Dr prescribed a sleeping
pill!!! GOD I really get tired of the pills!!! Seems like everytime I turn around it’s time to take another! If I can do that then I won’t have to take that stupid sleeping pill, which by the way will knock me out to where I can’t hear a tornado! That really dosen’t help when my 10 month old granddaughter comes over and starts crying in the middle of the nigh and I don’t wake up for her that one is up to my 17 year old then!

Hi, Heidi! ACE inhibitor is std protocol for Type 1’s, regardless of whether you have complications. You should be on one. I take a really low dose of Enalapril so that I do not get the “low blood pressure” dizziness.

Heidi, I fully understand your hesitancy to starting on another medication. We’ve all read about various medications Doctors regularly put people on that end up causing other problems after long term use. So starting another long-term drug at your age (you seem fairly young) shouldn’t be taken lightly.

My first advice would be to go to an Endo for a second opinion before starting a new medication. Very few GP’s are well versed in Diabetes and they often simply recommend a drug because that’s easier than trying to get you under really good control. If you have a good Endo, they may agree that if you can get your glucose under good control, there won’t be any reason to go on any other drugs. I had 2 different GP’s pushing pills (including the ACE inhibitors) at me every time I saw them, but my Endo saw how good of control I was able to achieve and he agrees that there’s no reason to put my on anything at this time.

My second advice would be to get you A1C’s down no matter what drugs you take. There are no magic pills, and while an Ace inhibitor might help prevent certain complications, if the root problem (poor glucose control) isn’t resolved you’ll simply have other complications.

My doctor wants to start me out on the lowest dose to see how it takes.I have ok blood pressure but of course it’ll drop it, how much did it drop yours?

I’m trying to get my a1cs down, I guess if they were good I wouldn’t really have to worry so much about “extra measures”. Good control is definatly the best prevention.

My BP varies between 130/80 and 105/65 depending on time of day, amount of exercise and how much of the Lisinopril is in my system. I have tried missing a dose and I’m about 140/90 so I would guess it actually lowers my BP about 10 points. I think BP is like BG in that if you have been high for a long time, normal levels feel like a hypo. Now that my BP is a bit more normal, I feel fine when it goes down as low as 100/60. So if yours is already in the normal range, you probably won’t feel any adverse effects from it going down a bit lower. If it is too much of a drop you can try cutting the pill in half and taking half twice a day until you get used to it. They don’t make anything smaller than 2 1/2 mg but that works fine for me. I think also that if you do get any side effects, they go away after a while. I was dizzy if I stood up quickly, walked up stairs or turned my head quickly. Taking the smaller dose helped but I do think I got used to the drug also.

Lisinopril has a side affect that made me cough. If that happens to you, ask your doctor to switch you to Diovan. BP is very important to keep under control. My high BP and low HDL probably caused me to burst a cap on my constricted arteries, resulting in a heart attack.
go to the middle of the page and read the section on “The coronary cascade”


I took Diovan for several years. One IMPORTANT thing to know about it is that if you are on insulin, is that it can affect your insulin resistance and cause lows because a unit drops you lower than you expect.

Hello Heidi, I too was placed on an ACE inhibitor when first diagnosed, I almost passed out twice from it. (My blood pressure runs low anyways), so I stopped it. My Endo currently at Stanford in CA tells me there is no proof that an ACE inhibitor prevents kidney damage. I have seen 4 Endo’s(I move around a lot), and only one suggested it. I do not take it, my brother took it only when he had protein in his urine. Other than that, you may want to talk to an Endocrinologist or do some checking online, find some research articles. Good luck, and research it out first. Denise

I wish I had been put on an ace inhibitor sooner. I have been diabetic for 11 years and just recently my endo noticed a small amount of protien in my urine. You cant imagine how freaked out I was esp after seeing my mother go through kidney failure and dialysis.

My endo put me on the ace inhibitor and told me to come back in 3 months time. I did as was told and my kidneys went back to normal.

My blood pressure is normal so he has me on only a 5mg dosage. Personally I think its worth taking. I have done nothing that would lead me to believe I should have kidney damage this early on. I would rather be safe then sorry you know?

Maybe if someone had put me on it as a preventive measure I would never have gotten the damage I wound up with. I will never know.

I had the cough too, but read somewhere that taking an iron pill would eliminate the cough. I tried that and it worked. After a year or so, tapered off the iron pill, and now have no side effects at all. At first I got the “low blood pressure dizzies” but after a couple of weeks that went away too. I’ve been on lisinopril for about 10 years no with no bad effects.

I switched endos because the one wanted me on an ACE and basically could not discuss anything else at my appointments.

There are too many side effects from the ACEs for me to take something that I don’t need to take.

I’ve been researching this recently because I have a random microalbuminuria reading of 35. After that I did a 24 hour which was 13, so I don’t have microalbuminuria, but it made me think. My endo isn’t pushing the ACE inhibitors, but my other doctor (actually a nurse practitioner) is. The thing is, I’m 20 years old with low normal blood pressure, and I don’t want lower blood pressure. I suspect that the benefits that have been seen are because it’s better to have low normal blood pressure than high normal, in terms of your kidneys.
I’m worried about the potential long term side effects, and I also have difficulty swallowing pills. I think that for as long as my blood pressure stays below average, I’ll stay off the ACE inhibitors. I do not think that there is conclusive evidence that ACE inhibitors are beneficial in terms of the creatinine clearance (which I think is far more telling than albuminuria levels) in people who are normotensive.

I have taken an ace inhibitor for almost ten years, no problems, it is a good thing and as my cardiologist says, nature can use an extra boost for some folks.

Rick Phillips