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Lisinopril for diabetes

Learn why your healthcare provider may prescribe this hypertension medication if you have diabetes
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By | Mar. 10, 2025 Medically reviewed by Anne Jacobson, MD, MPH
A prescription pad and a prescription bottle: Lisinopril for diabetes

Key takeaways

  • Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that’s prescribed primarily to treat high blood pressure. However, the effect of ACE inhibitors may help with certain aspects of diabetes, too.

  • Specifically, lisinopril may improve insulin sensitivity, protect the kidneys, and lower the risk of diabetes complications like stroke and cardiovascular disease.

  • The typical lisinopril dosage for people with diabetes is 10–40 mg per day. Healthcare providers will often start with 10 mg and titrate up from there.

  • Since lisinopril is a generic drug, insurance and Medicare Part D plans often cover it. Even without insurance, it’s fairly affordable, especially with coupons or other discounts.

In this article:

The American Heart Association says 50%–80% of people with Type 2 diabetes mellitus also have hypertension. As these are closely related conditions, it’s only natural to wonder if an antihypertensive drug like lisinopril could benefit people with diabetes. Lisinopril is FDA approved to treat hypertension in adults and children 6 and older, as well as heart failure and acute myocardial infarctions (heart attacks). It’s also used off-label to treat or slow the progression of various kidney conditions, including for patients with diabetes. 

How do ACE inhibitors like lisinopril work for diabetes?

Lisinopril (brand name: Zestril) doesn’t directly control blood sugar levels, so it’s not technically a diabetes medication. Rather, it belongs to a drug class called angiotensin-converting enzyme (ACE) inhibitors, which also includes ramipril and enalapril.

ACE inhibitors work through the inhibition of enzymes that produce a substance called angiotensin II, which constricts the blood vessels. This action decreases blood pressure and makes it easier for the heart to pump blood.

“It’s much like how water flows through pipes in your house,” says Danielle Kelvas, MD, primary care physician at The HCG Institute and founder of DKMD Consulting. “Water flows faster and at a higher pressure through smaller pipes, so lisinopril helps to make your blood vessels diameter a bit wider to lower blood pressure.”

Karishma Patwa, MD, a cardiologist at Manhattan Cardiology and contributor to www.labfinder.com, adds that ACE inhibitors reduce the risk of cardiovascular disease and stroke and prevent the development of kidney disease in patients with diabetes. “They also have the additional benefit of improving insulin sensitivity and glucose metabolism.”

ACE inhibitors are particularly useful for protecting kidney function in people with diabetes. “It doesn’t affect glucose control or lipid profiles negatively and is beneficial for cardiac and kidney health in patients with diabetes,” Dr. Kelvas says. 

So, while lisinopril might not be the first-line treatment for lowering blood sugar, doctors often use it or medications like it to help improve insulin sensitivity and reduce the risk of further medical issues.

Benefits and drawbacks of lisinopril for diabetes

Lisinopril can be a helpful drug for people with and without diabetes, but it has some downsides, too. Here are both sides of the coin.

Benefits

Drawbacks

  • Potential for hypotension: Depending on a person’s other medical conditions and medications, lisinopril might lower baseline blood pressure too far, causing symptoms like dizziness, weakness, and fainting.
  • Increased potassium levels: Excessive potassium in the blood is called hyperkalemia. Diabetes is a risk factor for it, and it’s also a possible complication of ACE inhibitor use, particularly in people with kidney dysfunction.
  • Rare kidney damage: While lisinopril typically protects the kidneys, it might cause kidney damage in certain rare cases or during long-term use.

Lisinopril dosage for diabetes

The typical dosage for lisinopril is 10–40 mg per day, and studies show that range is typically safe and effective when used to protect renal function in people with diabetes. One 2009 study of Type 1 diabetes suggested that 40 mg/day lowers blood pressure and urinary albumin excretion rate—how doctors test kidney function—more effectively than 20 mg/day. However, taking 60 mg/day didn’t offer any additional benefit.

But healthcare providers are unlikely to start with 40 mg right off the bat. “For patients who are naive to blood pressure medications, we would start off at a low dose to see if the medication suits them and then titrate the dose to achieve the blood pressure goals,” Dr. Patwa says. “The goal blood pressure for patients with diabetes is <140/90 or <130/80 millimeters of mercury (mmHg) if you have high-risk features.”

That dosage might also depend on the patient’s age, the severity of their hypertension, any side effects they’ve experienced while taking lisinopril, and their other medical conditions.

Lisinopril usually starts to work within a few hours of the first dose. However, it may take a few weeks of consistent use to reach its full benefits. The drug’s half-life is 12 hours, so it takes around 46 hours to completely leave the body.

Lisinopril side effects, warnings, and interactions with other diabetes drugs

The most common adverse reactions to lisinopril, according to clinical trials, are headache, dizziness, and cough. In rare cases, it may also cause serious side effects, such as allergic reactions, liver problems, hypotension, hyperkalemia, or angioedema (swelling of your lips, tongue, and face). Contact a healthcare provider if you notice any of these serious side effects.

Lisinopril may also interact with certain drugs. For example, diuretics, insulins, and oral hypoglycemic agents can increase the risk of hypotension, while nonsteroidal anti-inflammatory drugs (NSAIDs) may make lisinopril less effective. Taking other ACE inhibitors or angiotensin receptor blockers with lisinopril may increase the risk of hyperkalemia, hypotension, and kidney issues. Certain cancer drugs may increase the risk of angioedema. ACE inhibitors can also interact with lithium drugs and cause toxicity.

Pregnant women should not take lisinopril, since it can cause injury or death to the fetus. And breastfeeding mothers shouldn’t take it either, because it’s unclear how much of the drug is transmitted through breast milk.

Tell your healthcare provider about all prescription and over-the-counter medications you take, including vitamins, herbs, and supplements.

Lisinopril vs. other treatments for diabetes

Unlike diabetes medications, lisinopril doesn’t directly alter the body’s blood glucose levels. It primarily affects blood pressure and may indirectly affect blood sugar and protect against certain outcomes.

For example, biguanides like metformin lower blood sugar by decreasing the liver’s glucose production, while GLP-1 agonists like Ozempic stimulate the pancreas’ insulin production, and alpha-glucosidase inhibitors block the breakdown of carbohydrates. Lisinopril, on the other hand, widens the blood vessels, which might slightly improve insulin sensitivity by delivering insulin to cells more efficiently. However, this isn’t the drug’s main purpose.

That said, “angiotensin-converting enzyme inhibitors, such as lisinopril, and angiotensin II receptor blockers (ARBs) are both good options for blood pressure treatment, especially in people with diabetes,” Dr. Patwa says. So they can work well for people who have both hypertension and diabetes.

Will insurance cover lisinopril for diabetes?

“Lisinopril is a generic medication and is covered by most insurance plans for the treatment of hypertension.” Dr. Kelvas says. “I’ve never had an issue with a patient with diabetes getting lisinopril covered.” When it’s medically necessary and prescribed for qualifying conditions, most insurance, Medicare Part D, and Medicaid plans will cover it. 

How to save on lisinopril

Some plans might not cover lisinopril, “but even if it’s not covered, lisinopril is a very inexpensive medication—just a few dollars from local pharmacies,” per Dr. Kelvas. Without insurance coverage or any other assistance, the average out-of-pocket cost is $93 for 30, 10 mg tablets of lisinopril, but there are ways to get it for significantly less.

For example, a SingleCare coupon can drop that price as low as $3. SingleCare negotiates directly with thousands of pharmacies to get discounts on prescriptions and then provides those discounts for free to anyone with a prescription discount card.

Generic medications like lisinopril don’t have discount cards from the manufacturer, but insurance, Medicare Part D, and Medicaid can cover much of the cost. For uninsured patients, some pharmacies offer generic drugs at fixed low prices. Shopping around might pay off, too, since prices can vary quite a bit between pharmacies, even ones in the same town.