A List of Oral Medications for Diabetes 2 Treatment: Sulfonylureas
Walking
Part 1
When diagnosed with type 2 diabetes, your doctor will recommend that you to take two main steps: to increase your level of activity and to make changes in your meals.
However, sometimes these steps may not be enough to lower your glucose levels to a normal range or, over time, they may not continue to keep your level within your target range. Then your doctor may prescribe oral medication as a diabetes 2 treatment.
Pills do not contain insulin
People with type 1 diabetes make very little, if any, insulin, so they depend on insulin injections to reach normal blood glucose levels. Since the pills used to treat diabetes do not contain any insulin, they are of no use to people with type 1 diabetes. These pills can lower blood glucose levels, but only in people with type 2 diabetes whose bodies still make some insulin although not enough to perform the needed tasks.
The problems created with glucose control are caused by three areas:
- The muscles are not letting the glucose from the blood vessels enter into the muscle cells. This is known as “insulin resistance”. Your muscles are not responding to your insulin, and as a result, the level of glucose keeps going up in your blood.
- The liver produces too much glucose. This farther increases the level of glucose in your blood. This is how it happens:
- When you eat, your glucose level rises, which prompts your pancreas to release insulin. The insulin’s job is to usher glucose into the muscle cells. Now, when your liver sees the insulin in the blood, it knows that glucose has entered the system, so it stops releasing its own glucose stores.
- The insulin levels in your body normally decrease when your glucose levels drop, such as when you fast overnight or when it has been longer than four hours since you have eaten. Your liver sees insulin has decreased, thinks glucose is low, so it begins to make glucose to keep your levels in a normal range.
- But when your liver cells become insulin resistant, however, they cannot see the insulin in the blood and therefore they think that your glucose levels are low. As a result, your liver pumps out more glucose despite the fact that there is already glucose in the bloodstream waiting to get into your muscle cells.
- With so much glucose in the blood, the pancreas keeps producing insulin but the production cannot keep up with the high levels of glucose. Eventually, this excessive demand seems to poison the beta cells and they begin to die. When you reach a point where there are very few beta cells left, your blood glucose level increases greatly, causing extremely elevated blood glucose levels that are seen in uncontrolled diabetes.
And here is when your doctor will prescribe medication. The pills available to treat the elevated glucose levels work on these three problem areas by:
- Stimulating your beta cells to make more insulin
- Decreasing your liver’s glucose production
- Making your muscle cells more sensitive to glucose.
Oral diabetes medication categories
The oral diabetes medications available today fall into six categories. The six types have different actions and help glucose control in different ways.
Pancreas
- Sulfonylureas
- Biguanides
- Alpha-glucosidase inhibitors
- Thiazolidinediones (glitazones)
- Meglitinides
- DPP-4 inhibitors
Sulfonylureas
The sulfonylureas were the first pills ever available to treat diabetes. Prior to their introduction, insulin was the only treatment for elevated glucose levels.
Sulfonylureas work by stimulating your pancreas to release more insulin. The first medication that was available in this category is called Orinase (known generically as tolbutamide). It was followed by Diabenese (chlorpropamide) and Tolinase (tolazamide). These medications are often referred to as “first generation sulfonylureas”. The only medication used nowadays from the first generation is Chlorpropamide.
Since the 1950s, newer and stronger sulfonylureas have been released. These include the “second generation sulfonylureas”
- Diabeta, Micronase, and Glynase (all brand names for glyburide)
- Glucotrol and Glucotrol XL (brand names for glipizide)
A “third generation sulfonylureas” include Amaryl (brand name for glimepiride)
Side effects of sulfonylureas
The sulfonylureas all operate by the same mechanism. They work on your beta cells, pushing them to make more insulin in order to lower your glucose level. Because they continually work on your pancreas, they cause insulin to be released even when it may not be needed. This is the major side effect: they cause hypoglycemia or low blood glucose. Other side effects, although not common, are skin rashes, dark urine, stomach upset, and sensitivity to the sun.
Diabinese, a first generation sulfonylurea, has a longer duration of action in the body than the newer medications. With a prolonged duration comes a greater risk of extended and severe hypoglycemia. Diabinese can also cause hyponatremia (low sodium in the blood) and a flushing of your skin when you ingest alcohol.
How sulfonylureas are taken
Sulfonylureas are taken at the same time every day, generally about 30 minutes before a meal. If taken only once a day, they are usually taken with the first meal of the day.
Final thoughts
You know your sulfonylureas are working for you if your blood glucose values remain in a healthy range, you do not suffer any episodes of hypoglycemia and your HbA1c is below 7 percent. Check your blood glucose often, before and after meals, especially if this medication is newly prescribed or your dose has recently been changed.
If your numbers remain too high or too low, review your activity, your eating patterns, and whether you are missing some medication doses. If everything seems to be in order, your doctor may need to change your dose or switch your medication.
Don’t miss Part 2 of this series: Biguanides.
To your health!
Emilia Klapp, R.D., B.S.
www.TheDiabetesClub.com
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