Sulfonylureas for Type 2 Diabetes mellitus
It well known what sulfonylureas have been used for decades to control blood sugar. The drugs work by stimulating beta cells in your pancreas to produce more insulin. So, to benefit from the medication, your pancreas must be able to produce some insulin on its own.
Glipizide, glyburide and glimepiride second-generation medications are the most commonly used sulfonylureas. These newer versions of the original drugs are less likely to cause low blood sugar (hypoglycemia), and they don’t linger as long in your circulatory system, reducing your risk of complications from medication use.
Glipizide is available in two forms: a short-acting version and a sustained-release (XL) version. With the sustained-release version, you take the medication less often.
An advantage of the drug glimepiride is that it’s safer for individuals with impaired kidney function because the condition doesn’t affect the absorption and action of the drug. With other sulfonylureas, impaired kidney function causes the drugs to accumulate, increasing your risk of low blood sugar.
Sulfonylureas side effects
Low blood sugar is the most common side effect of sulfonylureas, especially during the first 4 months of therapy when the decrease in your fasting blood sugar is the most dramatic. You’re at a much greater risk of developing hypoglycemia if you have impaired liver or kidney (renal) function.
In fact, these conditions may influence your doctor not to prescribe a sulfonylurea. Research also suggests sulfonylureas may increase your risk of heart problems. However, one large study (United Kingdom Prospective Diabetes Study) found that people taking sulfonylureas didn’t appear to have an increased risk of heart problems.
Important sulfonylureas precautions
Doing anything that reduces your blood sugar after you’ve taken a sulfonylurea, such as skipping a meal or exercising more than usual, can lead to low blood sugar. Taking alcohol or certain drugs with sulfonylureas, including decongestants, also can cause low blood sugar by boosting the effects of the medication. Medications such as steroids, beta blockers, niacin and the acne drug Retin-A can decrease the effectiveness of sulfonylureas.
Talk with your doctor before taking any over-the-counter or prescription medication. It’s also best to have all of your prescriptions filled at the same pharmacy so that your pharmacist can be alert to any potential drug interactions.