March 22, 2023

Sulfonylureas (SU) were discovered in the 1950’s. In this class, glimepiride, glyburide and glipizide are the most commonly used in the United States today.

Did you guys know that before the discovery of insulin was made type 1 diabetics were actually treated with water from a bird pond they were treated with milk they were treated with cucumber flour and also with beer so we know now that none of those actually help cure or treat type 1 or type 2 diabetes and then insulin came along and that kind of changed the whole

Pathway of the management of type 1 diabetes and type 2. prior to that unfortunately all type 1 diabetics who still to this day need insulin for survival were died because they had no way to manage these patients however insulin was discovered so that kind of changed the whole game plan but after that then we started anti-diabetic oral medication that we use

To this day so guys welcome back to the voice of diabetes this is diana vitucci and if you’re wondering what class of medications i’m going to discuss today it’s going to be sulfurias what is that well safanurias actually were discovered in the 1950s when they found this uh this agent that was actually causing the low blood sugar levels and they said hey this is

Great we can use this type 2 diabetics because we know that the type 2 diabetics have high blood sugar levels so this causes low blood sugar levels why don’t we use this and bring blood sugars down so over the years we have numerous numerous of different cell phone ureas but right now believe it or not a lot of those has faded out and we are left with glimperite

Glipozite and glyburide as the three mostly used sofa ureas today and i use them myself in the endocrinology specialist warning sign i do not use sulfonylureas with type 1 diabetes because to date the only way to manage type 1 diabetes that is fda approved approved by the american diabetes association is insulin so if you’re reading any other any other sources

That tell you otherwise such as curing type 1 diabetes were earth i highly highly encourage you to discuss that with your provider because that can be extremely fatal for for type 1 diabetes these oral anti-diabetics especially this particular class we use for type 2 diabetes as you may know metformin is is the first line anti-diabetic oral agent that we use and

It happens to be one of my personal favorite of course and that is also backed up by the american diabetes association the ada a very reliable source that we use in endocrinology every day however i do have a video on metformin so if you are a metformin or you would like to learn what metformin is since it is the first line medication we use for a patient who’s

Developed uh either we use it in pre-diabetes we use it in diabetes but we also use it in different cases like pcos so make sure you guys check out my video on that form and i will link it at the end of the video after my foreman use a lot of different providers actually rely on sulfine urease as a second line and if a patient cannot tolerate metformin they usually

Go to sulfanuria as a second choice to use it for that patient so why are we commonly using this medication well it’s been around for a very long time and it’s inexpensive and it’s it’s generic so those are all things that we consider when we’re managing patients so cell phone ureas actually work and what they do is they tell you pancreas make more insulin so we

Know one of the defective things in type 2 diabetes is that the pancreas or the beta cells of the pancreas are not producing enough insulin therefore causing higher blood sugar levels in the bloodstream you know that this is a defect in type 2 diabetes so what sulfonylureas do is they they tell the pancreas hey you need to make more insulin because i don’t have

Enough that’s great because what we’re doing is we are talking directly to the pancreas and we are telling the pancreas hey you are not making enough of insulin so wake up and work harder believe it or not soft and urease actually reduce a1c a1cs even more than metformin does and other medications that we have it reduces it almost by two percent so let’s just say

You are that that patient tuning in today and your a1c is eight percent it can actually drop you down to about six point five or six percent percent just for the use of cell phone ureas so if this cost of medication is so great then why are we not using this class of medication as much as we should and why is it that the ada guidelines are actually recommending

Sulfonylureas last so they recommend a metformin first and then of course we have glp1 analogs now which are newer medications that actually help with weight loss and also help reduce a1cs and then we have sglt2 inhibitors like guardians or invokana and we know that those colossal medications are much more expensive than sulfonylureas are but why is it that we’re

Not all just automatically prescribing sulfanurias i do have patients on sofonureas it’s my least favorite class on medications and i’ve gotten a lot of emails and actually phone calls at work with patients who are watching my videos asking well what do you mean you don’t like this well you don’t like this class why am i on it so i don’t particularly like this

Class of medications because remember i said it really punches on the pancreas and tells the beta cells make more insulin whenever we are prescribing a medication that does that we know that we are always risking the chance of going too low the blood that it releases too much insulin at an unknown amount of time and therefore causing what we call hypoglycemia and

For anyone that’s ever experienced hypoglycemia we know how terrible hypoglycemia is and how dangerous it can be another reason why i don’t like this medication amongst others and why it is not favored by the american diabetes association so they cause weight gain whenever we’re talking about diabetes even non-diabetes anything that we hear that causes weight gain

Most of us are like pushed me away from that because i don’t want to gain any more weight but when we’re talking about type 2 diabetes we know that many type 2 diabetics already struggle with weight therefore adding more weight only further complicates diabetes because the more weight we gain the more insulin our body needs to produce and we know that another defect

Is that our pancreas cannot produce enough insulin so it just causes a chain reaction where our weight goes up our blood sugars go up and we need to continuously add more and more medications to try to bring the blood sugars into more normal value another reason why i don’t like this class on medications in particular is because remember i mentioned that it punches on

The pancreas to say make more insulin make more insulin well just you’re over driving the pancreas so you’re making the pancreas work extra hard extra hard eventually the pancreas says you know what i’m done i can’t produce any insulin so actually studies show that introducing sulfonylase very very early on in in the diagnosis of diabetes actually makes the pancreas

Shut off quicker so let’s just say um you know you were diagnosed one year ago and you’ve been on a sulfonaria without trying the newer medications first what it could do is that it shows that those patients who are introduced to sophomores very early on may require insulin much sooner than they would than they would if they had not been insulting urea and of

Course remember if i have a patient with liver disease if i have a patient with kidney disease soft and urease are usually a no go for me after age 50 or 60 i normally discontinue cell phone ureas but why do we still use them is the question well remember all we have to consider a lot of different things when we’re treating patients one is that sometimes patients

Cannot tolerate anything else they might not tolerate metformin they might not be able to afford the newer medications and we know that cost is always an issue so if the patient can only get this medication obviously we’re going to treat with sulfaneurias rather than than not treating them at all because we know that getting the diabetes or the blood sugars under

Control is the key factor and that’s the outcome we want because we want to prevent organ damage such as kidney disease eye disease heart attacks stroke imputations and so much more which i will talk about in the upcoming videos so do i have patients on sulfine urease absolutely but i try to avoid at all costs if i can utilize the better medications like metformin

And glp1 analog which i have videos on both of those clouds and medications but also sglt2 inhibitors and many more other classes that i’m going to talk about but yes esophagus although we use them if i can choose between the newer class of medications i’m always going to choose the newer class of medications because those work much better and they don’t have all

Of these side effects that i talked about such as the hypoglycemia or the weight gain which we always try to avoid whenever we can so guys if you are that patient on a sofa area i’m not asking you to call your provider and say hey why the heck am i taking this because there may be a very good reason why you are on it and i have patience and i discuss this with my

Patients all the time i say oh you know this is not my favorite class of medication but unfortunately this is the best option for you at this time and you know patients understand and i usually have patients check their blood sugars more regularly if they are on esophagea versus metformin um just because of the fear that they can go low and i always discuss the

Signs and symptoms of hypoglycemia so they are aware if they were to have that kind of reaction i really hope you guys enjoyed the video if you have any questions on glimepiride glyburide or uh glipizide please comment below and share your stories with me i would love to hear them and uh please just make sure you guys are understanding that yes we still use this

Class of medications but when when it can be avoided we really try to use this as the last resort and i’m also just for educational purposes sometimes i will use sulfonylureas actually as first line if i have a patient who’s on chemotherapy or if they’ve gotten like a steroid injections for their shoulder or their knee i will use this for a few days only because

We know that their blood sugars tend to run much higher after steroid use so i’ll use it for about three days just you know um just so we can keep their blood sugars at bay um and then of course we discontinue it so sometimes i will use it for a very short period of time for someone who is undergoing chemotherapy or getting some type of steroid treatment um just

Because you know their blood sugars tend to run much higher for a few days afterwards and the day of so i’ll use a short term and then i tell them you no longer need this we just used it for those three four days so that their blood sugars will not spike out of control um so that’s something that i do and a lot of endocrinologists do that but again you always want

To consult with your doctor and your provider to see what is the best option for you i will see you guys all next time take care

Transcribed from video
Glimepiride, Glyburide, Glipizide. Everything about Sulfonylureas! By The Voice of Diabetes