 One factor that might aggravate glucose metabolism during therapy with diuretics is the underestimated effect of hypokalemia, which interferes with glucose-stimulated insulin release, a condition that might be aggravated by association with beta-adrenergic block 19,20. Among other beneficial effects, including improvement in blood pressure control, correction of hypokalemia prevents or significantly reduces thiazide-induced hyperglycemia 21-24. It is possible that low-dose potassium-sparing diuretics by preventing hypokaleemia might also prevent metabolic effects of thiazide, at the same time enhancing the antihypertensive effects of thiazide 25, but, this hypothesis has never been tested in ad hoc trials. 