Skip to content

How Sulfonylureas Work: with Pros and Cons – Glyburide, Glipizide, Glimepiride -Type 2 Diabetes#16

  • by

Today we are going to talk about some medications that make your beta cells release insulin, the ones that we call Sulfonylureas. The most commonly used Sulfonylureas are Glipizide (Glucotrol and Glucotrol XL), Glyburide (Diabeta, Micronase, and Glynase PresTab), and Glimepiride (Amaryl).

Hi welcome to type 2 diabetes number 16. today  we’re going to talk about a class of medications   that force your beta cells to release insulin.  this was a question from an excellent subscriber   that always writes good comments on my videos.  so, thank you! she basically wants to know how   glyburide works. glyburide,

Just like glimepiride  and glipizide and, you know, a lot of other ides,   sulfonylureas. and today we’re going to see   how they work. now, always remember that if you  should take medications or not it’s between you   and your doctor! my goal is to explain to you  clearly how they work, so that you can understand  

Medications, or you know, any other medication.   now, how do these sulfonylureas like glyburide  and glipizide work? i told you that when you eat,   your blood sugar goes up, right? and these glucose  will get inside the beta cells of the pancreas   and force them to release insulin. i always say  that glucose will force the

Beta cells to release   insulin, right? because it’s not like your beta  cake, so let’s just release some insulin to   take care of it. no, glucose will personally get  inside the beta cells and get the job done. so,   that this is a beta cell from the pancreas.   private jet, like i told you before. glucose   will

Be metabolized and converted to energy.   you know. but i think a lot of people are not  using cash nowadays, so anyway. now, atp is the   of your beta cells, there are two channels,   one and two. now, the first one is a potassium  channel. this channel is sensitive to atp.   can get out of the cells, can leave the cells,

To  keep the cells cool, you know, relaxed. i know,   say cool because they literally keep the cells   of the cells. and inside the cells will be   do anything. they just stay there. now,   when there’s a lot of energy inside the cells,  a lot of these atp… can block these channels   potassium is positive so

A lot of positive   cells, and the cells will start getting hot.   okay, again the technical term is depolarized,  but i say hot because they literally get hot,   there’s a lot of electricity building up inside  the cells. and there’s another channel that can   sense the electricity. and these calcium channels,  they

Can sense the voltage. they can sense that   the cells are getting hot. when the cells are  getting depolarized, these channels will open   and a lot of calcium will start getting inside  the cells. and this calcium will make sure   that the insulin vesicles that are already here,  will get linked to the membrane and a lot of

This   insulin will be released. well let me just change  the color of the insulin to not confuse you. now,   when insulin is released, you know that insulin  will make sure that these glucose can enter   different cells in your body, especially muscle  cells and fat cells, where they can be used for   energy or they

Can be stored as glycogen and fat.  but we already know that. so someone said, wait   be released. why don’t we just make something   will come all the way here and block this   channel. and this is what glyburide does. well  actually the first medications that were found   to close these channels, they were discovered

By  accident, but later they made these glyburide and   glipizide and other ides that can come all the  way here and block these channels. when they block   these channels, you know what will happen. the  cells will get hot, these channels will sense it   the cells, and insulin is released. now,   pros and cons of

Taking these medications? the   first positive thing about these medications is  that they work right away, they’re not trying to   reduce your insulin resistance and maybe later try  to improve your blood glucose or this or that. no,   close these channels and make sure they   release insulin. insulin will take care of

The  glucose right away! so they just work fast,   faster than other medications and they generally  reduce your a1c better than most other diabetes   with these medications, you know, because   300 when i eat but now with these medications   now another thing about these medications is that  they’re cheap. they’re

One of the first ones to be   normally very cheap and everyone can afford them.   medications that make me not like them so much.   the first one is that they can cause hypoglycemia.  and the reason why, is that as i told you   these medications can also force your beta cells  to release insulin, right? but the difference

Is   that the entering of glucose into your beta cells  is dependent on the concentration of glucose.   glucose will get inside the beta cells,   and a lot of insulin will be released. but if  there’s very little glucose, less glucose will   enter the beta cells, and less insulin will be  released. but when it comes

To these medications,   the amount of insulin that is released is not  dependent on the concentration of glucose.   for example, if the dose is too much, maybe a lot  of insulin will be released. it doesn’t matter   if your glucose is high or low, these medications  will just go and close the channel and the insulin  

Will be released. so with these medications if  you take a little bit more than what you need,   have hypoglycemia. or let’s say you eat a   different meal that does not raise your blood  sugar to match the level of the medication,   skip a meal and you do not skip the medication,   you will have hypoglycemia. because they

Will just  go straight to your beta cells and force them to   release insulin, independent on the concentration  of glucose. so, that’s why patients that are   and all these ides, they’re normally told to   walk with, you know, some kinds of sugar in their  pockets just in case something goes, you know.   medications

Is that they can cause weight gain.   as i told you, they will force the beta cells to  release insulin, right? and you know that insulin   muscle cells and fat cells, and they will be used  for energy or stored as glycogen and fat. now,   let’s say that you’re someone who’s very active  and you, you know, with a lot of

Muscles and   you do a lot of exercise, maybe most of them will  go to muscle cells. but let’s say you’re someone   who just sits on the couch then a lot of these  glucose will go to fat cells and you know you will   keep getting bigger and bigger. but, i already  made a video that shows the difference between  

Glucose getting into your muscle cells and fat  and another thing that can cause this weight  gain is that patients know that they can have   hypoglycemia, so they tend to eat more than what  they need. and patients on these medications   many snacks during the day just in case. and,   people to eat more and they will even

Gain   more weight. but you know that most patients with  type 2 diabetes do not need more weight, because   that was your problem in the first place. so, when  you take these medications they’re not fixing your   problem at all. they’re reducing your blood sugar  that can help you prevent some complications,   but

They are not fixing your problem at all. on  my last video, i spoke about sglt2 inhibitors,   your problems. you are throwing the glucose into   the toilet with those ones, you know. they’re  expensive but at least they’re fixing some of   the problems. too much glucose inside your body…  getting rid of it. but this one does

Not, it just   puts them into your cells. now, there are some  other things that i also don’t like about these   medications. you know that they’re forcing your  beta cells to release insulin, right? so, if you   were someone whose beta cells were already…  i mean, most of them were already gone or   cells working,

When you take these medications   without taking care of the real problem,   you might destroy them even faster. so if patients  just take these medications and do not take care   only work for a few years and then you realize   that your beta cell function will decline even  faster. and after sometime they’re gone, and

You   need insulin. so these medications will never  and lastly, there are some studies  can increase cardiovascular events. not all  studies say this but at least many of them.   and when you compare them to medications like  metformin or sdlt2 inhibitors that decrease your   heart problems, then it doesn’t make sense

For  you to take these ones first. but you know, some   patients take them without any problems. like, for  enough insulin. you only had problems with   atp to push them, there were not enough atp to   make sure that the cells release insulin,   a long time because your problem was not   with good beta cells,

They have insulin but   they become less sensitive to atp then when   you take these medications they will just work  wonderfully for a long time, for many years. so,   these medications are not their first choice.   not first and not second. now, there are other  things that might happen for some people, like  

These are not only for these medications.   other medications can also cause those things,  so i did not put them here in the list. now   let me ask you one question? do you think these  medications can help people with type 1 diabetes?   force your beta cells to release insulin,   but patients with type 1 diabetes, they

Don’t  have functional beta cells, the immune system   destroys them. so, for those patients if they  take these medications, it will not work. and   that are at the last stage, that do not have   a lot of functional beta cells, these medications  will also not work well. now i hope now you know   how these medications

Work and you can understand  some of the pros and cons of taking them. now if   you are taking these medications or you’ve taken  them before, please write them in the comments   section and tell us how many of these you have  experienced. and for now, have a blessed week. bye

Transcribed from video
How Sulfonylureas Work: with Pros and Cons – Glyburide, Glipizide, Glimepiride -Type 2 Diabetes#16 By Type 2 Diabetes – Dr. Vladmir Carvalho