Sulfonylureas

Sulfonylureas are the oldest group of Type 2 diabetic medication in the US, and also the most diverse. This class of drugs works by enhancing the body’s production of insulin over a 6 – 24 hour period (depending on which specific sulfonylurea you are taking). Because these drugs act over such a long period of time, regardless of fluctuations in blood sugar during that time, there is a danger of hypoglycemia. Patients taking sulfonylureas should be sure to keep a handy form of sugar with them, in case hypoglycemic symptoms arise.

Sulfonylureas currently used to treat Type 2 diabetes include:

  • Orinase (tolbutamide)
  • Tolinase (tolazamide)
  • Glucotrol [XL] (glipizide [extended release])
  • Micronase, Diabeta (glyburide)
  • Glynase (micronized glyburide)
  • Amaryl (glimepiride)

Each of these medications has different dosage strengths and durations of effect, and people who have a negative reaction to one sulfoylurea may be able to take a different one without a problem. Some of these medications are only taken once a day, while others may need to be taken up to three times per day. If you are familiar with your usual blood sugar patterns, you and your doctor should be able to determine which of the sulfonylurea medications would work best for your case.

Because these drugs work by enhancing the body’s own production of insulin, patients with Type 1 diabetes or Type 2 diabetes who’s beta cells have stopped producing insulin cannot use sulfonylureas.

Orinase and Tolinase bind to particular proteins in the bloodstream, and can be “dislodged” by other substances that interact with the same proteins. When this happens, their effect on the body is suddenly greatly enhanced, and sudden, severe hypoglycemia can result. One older sulfonylurea od this type was phased out of use, because it’s extremely long effective period would cause very long-lasting hypoglycemic episodes. However the generic form of this drug (chlorpropamide) is often found on over the counter “herbal” diabetes supplements. Because of this potentially dangerous side effect, “herbal” diabetes products should be avoided.

The other sulfonylureas do not bind to blood proteins, and therefore have more stable effects on the patient’s blood sugar levels. Amaryl also shows an effect on insulin resistance, which seems to make it even less likely to cause severe low blood sugar.



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