Diabetes and YOU: Sulfonylureas

Ok guys, it's time to pick up where we left off! We are heading back to the topic of diabetes! Let me just refresh your memory. Based on statistics released this January, 25.8 million children and adults in the United States, roughly 8.3% of the population have diabetes.There is still a whopping 7 million people undiagnosed and 79 million prediabetics in the US. Today, let's discuss the sulfonylureas, a class of oral hypoglycemics that are widely used for diabetes mellitus (type 2) management. In the following paragraph, I'm going to enlighten you on the mechanism of action, side effect profile, clinical effects and additional clinical pearls of this particular class of medication!  Let's begin, shall we?
First off, understand that the class sulfonylurea is broken down into three generations, first, second, and third generation sulfonylureas. Please find a list below....this list is not inclusive of EVERY sulfonylurea on the market!
1st Generation

1. Orinase (tolbutamide)
2. Tolinase (tolazamide)
3. Diabinese (chlorpropamide)

2nd Generation

1. Glucotrol & Glucotrol XL (glipizide)
2. Micronase, Diabeta, Glynase (glyburide & micronized glyburide)

3rd Generation

1. Amaryl (glimepiride)

Sulfoynylureas are very specific in their mechanism of action. They increase insulin production by acting directly on the beta cells of the pancreas. Although, there are many side effects of this class of medication, including bloating, nausea, heartburn, anemia, weight gain, sun sensitivity, metallic or change in taste, as with many other blood sugar lowering agents, the most prominent side effect of concern is....you guessed it....low blood sugar! The first generation is notoriously known to drop blood sugar more so than the second or third generation due to the fact that they can be easily displaced from their protein binding sites...thereby increasing their activity in the blood stream. So now that you've learned the basic activity and side effect profile, here are a few take home points when using these medications.
1.  May be taken with or without food however, Glucotrol (immediate release) should be taken prior to meals.
2.   Use caution and/or seek guidance from a healthcare professional if you have allergies to sulfa drugs.
3.  Be sure to maintain normal eating habits with oral hypoglycemic agents on board...helps minimize chances of hypoglycemia (low blood sugar)
4.  Always maintain a diabetic diet...low carbs and sugar
5.  Be sure to ask questions about any medications that you are taking after all....it is your life and your health!