QUESTION: What is the connection between lisinopril, diabetes, and kidney function? Does lisinopril protect the kidneys, and what side effects or monitoring are needed?
Lisinopril is an ACE inhibitor used to lower blood pressure and treat certain heart conditions. In people with diabetes, hypertension, and albumin in the urine or reduced kidney function, it can reduce pressure inside the kidney filters, lower albumin leakage, and slow kidney disease progression. It does not directly treat high blood sugar and is not prescribed to every person with diabetes. Kidney function and potassium must be checked because lisinopril can sometimes cause high potassium, low blood pressure, or worsening kidney function.
Answer by Dr. Albana Greca, MD, MMedSc
Hi there,
Lisinopril blocks angiotensin-converting enzyme, reducing the formation of angiotensin II. Angiotensin II normally tightens blood vessels and stimulates aldosterone, which promotes sodium and fluid retention. Reducing these effects lowers blood pressure and changes pressure within the kidney’s filtering units.
Diabetes and high blood pressure can damage the glomeruli, the small filters inside the kidneys. Lisinopril relaxes the blood vessel leaving each glomerulus, reducing excessive pressure inside the filter. This can lower albumin leakage into urine and slow kidney damage in appropriately selected patients.
Current guidance recommends an ACE inhibitor such as lisinopril, or an angiotensin receptor blocker, for many nonpregnant people who have diabetes, hypertension, and increased urine albumin. The benefit is strongest when urine albumin is severely increased or estimated glomerular filtration rate is below 60. Our guide to diabetes and kidney disease explains the tests used to detect these changes.
Lisinopril is not routinely needed only because a person has diabetes. It is not recommended solely to prevent kidney disease when blood pressure, urine albumin-to-creatinine ratio, and kidney filtration are all normal.
Lisinopril is not a glucose-lowering medicine and does not replace diabetes treatment. However, when it is started together with insulin or glucose-lowering tablets, some people may have an increased risk of hypoglycemia. Monitor glucose more closely if your clinician advises, especially after starting treatment or changing doses.
Continue following the diabetes plan prescribed by your healthcare team. Our overview of diabetes medicines and their effects can help you understand how glucose-lowering treatment differs from blood-pressure treatment.
Before starting lisinopril and after initiation or dose changes, clinicians commonly check:
A small early rise in creatinine can occur because pressure within the kidney filters changes. A rise of up to about 30% may not require stopping treatment when the person is not dehydrated and potassium is acceptable, but only the prescribing clinician should interpret the change.
A dry, persistent cough is a common reason people ask to change from an ACE inhibitor to another medicine. Dizziness may occur if blood pressure falls too low. Lisinopril can also raise potassium or worsen kidney function in susceptible people.
Rarely, it can cause angioedema—sudden swelling of the lips, tongue, face, or throat. This is a medical emergency. Read more about medicine precautions in our diabetes drug-safety guide.
Tell your clinician if you use ibuprofen, naproxen, other NSAID pain relievers, potassium supplements, potassium-containing salt substitutes, spironolactone or another potassium-sparing diuretic, lithium, an ARB such as losartan, or aliskiren. Some combinations increase the risk of high potassium, low blood pressure, or acute kidney injury. Lisinopril and an ARB should not routinely be combined.
Vomiting, diarrhea, poor fluid intake, or severe dehydration can also increase the risk of low blood pressure and kidney injury. Ask your clinician for clear sick-day instructions rather than stopping the medicine without advice.
Seek emergency help for swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; fainting; or signs of a severe allergic reaction. Contact your clinician promptly for markedly reduced urination, severe weakness, an irregular heartbeat, persistent vomiting or diarrhea, or severe dizziness. Lisinopril can harm a developing fetus and should not be used during pregnancy; contact the prescriber immediately if pregnancy occurs or is planned.
Lisinopril may protect the kidneys when diabetes is accompanied by hypertension and albuminuria, but it can also harm kidney function in certain situations. The decision should be based on blood pressure, eGFR, urine albumin, potassium, other medicines, hydration, and pregnancy status. Do not start, stop, or combine blood-pressure medicines without the prescribing clinician.
Educational safety note: This answer is for general diabetes education only. It does not replace personal medical advice, diagnosis, or treatment. Do not start, stop, or change medicines, supplements, diet, or exercise plans without speaking with your healthcare provider.
Last reviewed: July 2026.
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