DIABETES - WHAT YOU NEED TO KNOW !! (PART - FOUR)

Hi there...

Hope you all enjoyed a beautiful Diwali...

Here in Chennai it was a wonderful weather with Monsoon setting in making Chennai a “cool” place.

Last three weeks I have written about three important topics

DOCTOR SELECTION

METFORMIN

ALPHA GLUCOSIDASE INHIBITORS.

Now we will discuss about one of the main PILLARS of diabetes management – Sulphonylureas

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These classes of drugs were introduced in the 1950’s....  A classical example for “Accidental Discovery”... Yes, the blood sugar reducing potential of these compounds was discovered as a side effect... Actually at that point of time scientists were busy discovering oral antibiotics. When some of the sulphonamides were used for treating infections in diabetic patients they also noticed a remarkable reduction in blood and urine sugar values. This slowly translated into the first generation sulphonylureas – Carbutamide, Tolbutamide, Chlorpropamide and Tolazamide. These drugs were very effective in treatment of Type 2 Diabetes.  These drugs helped millions wean off insulin and live a near normal life. Unfortunately these drugs were taken off due to harmful side effects on bone marrow and blood profile. The next generation drugs which we are using are

Glibenclamide – DAONIL ^*

Glipizide – GLYNASE ^*

Gliclazide – DIAMICRON, RECLIDE, GLYCINORM ^*

The latest member of the family is Glimipride- 3^rd Generation Sulphonylurea (AMARYL, GP, GLIMESTAR^*). This molecule claims to have a cardioprotective effect and is supposed to give a smoother control of blood sugars.

How do these drugs work?

To put it in very very simple words these drugs bind to receptor on the cell membrane of pancreatic beta cells (insulin producing cells) this binding results in a series of chemical reactions and finally increases the intracellular calcium level in the Beta cell leading to release of insulin. So basically speaking these drugs do not increase insulin production. They only help to bring out the already produced insulin.

How to take these drugs?

For some unknown reasons the timing of these drugs are not given due importance. The mode of action which I have explained here is an over simplified version. It contains more intricate steps which needs time. In order to obtain the full benefit of the drug and to get a proper sugar control Sulphonylureas have to be taken 30minutes before food. This family currently comprises of 4 members and all of them come as plain tablets or in combination with metformin or as a megamix of sulphonylurea + metformin + pioglitazone. Personally i do not prefer using triple drug combinations as dose adjustments becomes more confusing plus the chances of appearance of unwanted side effects are more when such multiple combinations are used.

Disadvantages.

These drugs are like a boon to Diabetic patient saving him from daily pricks for approximately 10-15years. Lucky are those who continue to get better control after 20years with oral drugs. All these drugs come with minimal side effects which may be clinically evident in a very small percentage of patients. So I am not going to discuss about them in detail. But, the most common disadvantage with this group of drugs is that they can push you into severe hypoglycaemia if used inadvertently...

Winding  up....

Sulphonylureas are real pillars for effective management of Diabetes. Used as per recommendations they serve you well. When dosing sulphonylureas the chances of hypoglycaemia have to be kept in mind. Never try to double the dose of half the dose without expert help. I think i have covered the most important drugs used in Diabetes. My next post would be on Newer drugs used in Diabetes..

Till then.....

Take care...

Bye....

Dr.Riyaz Sheriff

Consultant Diabetologist

^*- Trade names are used only for the sake of familiarity. Author does not intend to support any of these brands using this blogpost..