Sulfonylureas for type 2 diabetes

Examples
Generic Name Brand Name
glimepiride Amaryl
glipizide Glucotrol
glipizide and metformin Metaglip
glyburide DiaBeta, Glynase, Micronase
glyburide and metformin hydrochloride Glucovance

Most sulfonylurea medications for type 2 diabetes can be taken once a day. Some need to be taken twice a day.

These medications work for a long time and can cause low blood sugar. It is very important not to skip or delay meals when taking these medications.

Glucovance is a combination medication that contains glyburide and metformin hydrochloride, a biguanide.

Metaglip is a combination medication that contains glipizide and metformin.
How It Works

Sulfonylurea medications:

* Increase the amount of insulin produced by the pancreas. This is the primary action of these medications.

Because Glucovance and Metaglip are combination medications that contain metformin, they decrease the amount of sugar your liver makes and may increase your body's ability to respond to insulin.
Why It Is Used

Sulfonylurea medications are prescribed when changes in diet, weight loss, and exercise do not keep the blood sugar level within a safe range. When taking one of these medications, it is still important to eat a balanced diet, exercise, and lose weight if needed.

These medications can help control blood sugar levels in children and young adults who have type 2 diabetes and are overweight.

Sulfonylurea medications are not safe if you:

* Are pregnant or trying to become pregnant. They may harm the fetus.
* Have liver or kidney problems. Sulfonylurea medications are broken down by the liver and pass out of the body through urine produced in the kidneys.

Tell your doctor if you have had a serious allergic reaction to a sulfa antibiotic, such as Bactrim or Septra. You may not be able to use a sulfonylurea.
How Well It Works

Sulfonylurea medications work rapidly to control elevated blood sugar levels; they often are the first medication selected to treat people newly diagnosed with type 2 diabetes. Metformin is preferred for initial treatment because it doesn't cause low blood sugar or weight gain. The great majority of people have better control of their blood sugar by using a sulfonylurea medication along with diet and exercise than by using diet and exercise alone.

However, the medication may become less effective after several years of use. Some people who no longer respond to one sulfonylurea may respond to a different one.

Results of the United Kingdom Prospective Diabetes Study (UKPDS) showed that sulfonylurea medications:

* Were as effective as metformin and insulin in reducing blood sugar levels of people with type 2 diabetes.1
* Decreased the risk for complications of the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy).2

Sulfonylurea medications do not decrease fat (triglycerides) in the blood as does metformin.
Side Effects

Side effects are uncommon when sulfonylureas are taken as prescribed. Low blood sugar is the most common side effect. The risk of very low blood sugar is greater with medications that work longer in the body.

Drinking alcohol increases the risk of a low blood sugar level if you take a sulfonylurea medication. If you drink alcohol, limit yourself to only 1 to 2 drinks per day and eat something before you drink alcohol.

Sulfonylurea medications can cause weight gain. They also tend to keep insulin levels in the body high for long periods of time. Over time, high levels of insulin (hyperinsulinemia) may increase your chances of getting heart disease.

Blood levels of vitamin B12 can decrease in some people who take metformin.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About

Sulfonylurea medications are an effective treatment for many people with type 2 diabetes. If one of these medications keeps your blood sugar within a safe range, your risks of long-term complications of diabetes can be reduced. Other important factors that contribute to complications include high blood pressure, being overweight, high cholesterol levels, and smoking.

Few studies have been done on the use of oral medications for type 2 diabetes in children, and they have not been approved by the U.S. Food and Drug Administration (FDA) for use in children. But because these oral medications are safe for adults, most health professionals use them to treat children with type 2 diabetes.