Sylfonylureas

If you have not already done so, please read my introduction page (HERE).

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Unlike many of the other articles in this series that give extensive explanation as to how the drug class work, this article will be more brief and will be nearly identical to the article on Meglitinides (HERE).

How does this drug class work?  This drug class works by stimulating (more accurately: forcing) your pancreas to make more insulin.  It works similar to the class Meglitinides, however, rather than stimulating a rapid, short-duration, insulin release like Meglitinides do, this class stimulates a sustained insulin release.  So, this medication is often taken just once daily.  However, some may be prescribed this medication 2 or even 3 times daily, always before meals.  Since this drug increases insulin, it should always be taken before a meal (never, say, at bedtime).

Obviously, since this drug makes your pancreas release more insulin, it is not suitable for Type 1’s who do not have the ability to produce this insulin.  This drug is for Type 2’s only.

This drug class has an A1c lowering ability of 1.0 to 2.0% (1).

Side effects include, low blood glucose (hypoglycemia) and weight gain.  Studies also suggest increased cardiac risk factors with use of this drug class.

Drugs in this class include: Amaryl (glimepiride), Glucotrol (glipizide), Glynase / Diabeta / Micronase (glyburide).

Drugs in this class also are produced in combination with metformin and are marketed under various names around the world.

 My Opinions

If you are only interested in the facts about this drug and how it works, feel free to stop here.  The following are my concerns with this drug class and my personal opinions.

Disclaimer:

Please note, in providing my personal opinions with concerns for these medications, once again, these are my opinions only and not intended as advice for you personally.  Please consult your personal healthcare provider to discuss the benefits and risks of any medications prescribed for you.

So, here are my thoughts.  In order for someone to understand why I am concerned about drugs that increase insulin, it is important to understand how these drugs could potentially contribute to increasing insulin resistance and worsening your underlying diabetes.  Please read my page “Insulin Resistance” HERE.

Now, once you have read this, you can understand my concerns that drugs which increase insulin, can lead to increased insulin resistance and worsening diabetes.  You may also begin to understand how a drug that increases insulin (and insulin resistance), contributes to increased cardiac risk.  The greatest risk factor for cardiac events is the presence of metabolic syndrome (also sometimes called insulin resistance syndrome).   Worsening insulin resistance, increases cardiac risk.

As you know, I recommend a low carb lifestyle for all people, but PARTICULARLY as a first line of defense in the treatment of diabetes, NOT drug therapy.

(Why A Low Carb Diet Should Be the FIRST Approach in the Treatment of Type 2 Diabetes HERE.  Low Carb Diet Recommended for Type 1 and Type 2 Diabetes HERE.)

I believe that drug therapy has it’s place, but ONLY to address any issues after a healthy, low carb lifestyle, exercise and other lifestyle practices are ALREADY in place.  So, if you are already practicing these things, I find it hard to see where this drug class might be of any benefit.  Many taking this drug experience significant hypoglycemia when improving their lifestyle factors (low carb eating, exercise, etc.)  Keep in mind, the A1c lowering capability of this drug is extremely poor when compared to low carb.

Above all, REMEMBER, diabetes is a problem of GLUCOSE INTOLERANCE.  The answer to that problem is not “take in all the glucose you want and then take a drug to make it go away.”  That is like telling someone with lactose intolerance to “eat all the milk and cheese you want and we’ll give you a pill to try and make it better.”  No!  People with lactose intolerance are told not to eat milk and cheese.  It is the same with diabetes.  People with diabetes should consume as little of the foods that turn quickly into glucose as possible.  Then, there will be no need for pills to increase insulin production.

Once again, this is my personal opinion.

To further my opinion, I would emphatically state that I would never personally take any drug in this class…period.  There ARE medications that I would take to treat diabetes if my low carb healthy lifestyle was not enough to control my blood glucose.  None of the drugs in this class are among those I would consider.

Here is a bigger concern with this drug class.  It is estimated that at the diagnosis of Type 2, a person may have as little as 20% beta cell function left (1).  (Beta cells are the cells in your pancreas that make insulin).  So, to take a drug that forces your pancreas to crank out more insulin, just may well damage what little beta cell function a person has left.  If you actually DO have a deficiency in insulin, and you are going to increase your insulin levels anyways, why not just take insulin and give your pancreas a break?  There is evidence that once the beta cells get a rest, through insulin use, they can actually slightly improve in their functioning.  I would definitely favor insulin use over this class of drug.  If you do not have an insulin deficiency, then I would not recommend insulin.  If you are making plenty of insulin, then more insulin is not the answer.  It is my firm belief that a person’s current ability to produce insulin should be evaluated before considering insulin therapy.

Here is an extremely well-researched article by a website which I highly respect, expressing additional concerns about this drug class HERE.