Showing posts with label SULFONYL UREA DRUGS. Show all posts
Showing posts with label SULFONYL UREA DRUGS. Show all posts

Use of sulfonyl urea drugs with insulin .. Insulin secretion of beta cells and increase sensitivity and response of peripheral tissue to insulin

Use of sulfonyl urea drugs with insulin

Sodium sulfonate medications as mentioned not only alert the secretion of insulin from beta cells, but also increase the sensitivity and response of peripheral tissues to insulin.

So the use of these drugs will reduce the total dose of insulin necessary to control the high blood sugar level.

At present, information on the administration of these drugs with insulin is still limited in terms of total physical cost in the case of prescribing sulfonil urea with insulin for patients with type II diabetes.
However, patients who do not respond to more than 100 units per day of insulin may prefer to administer both sulfonylurea with insulin rather than continuing to increase the total dose of insulin.

What causes increased insulin sensitivity?

Chromium, berberine, and magnesium supplements are linked to increased insulin sensitivity. Resveratrol appears to increase insulin sensitivity, particularly among people with type 2 diabetes.

What drugs increase insulin sensitivity?

Two types, or classes, of diabetes drugs make your cells more open or sensitive to insulin. These medications are biguanides and thiazolidinediones (TZDs).

Can you use sulfonylureas with insulin?

Combining insulin and sulfonylurea is usually not endorsed, as they have similar mechanisms of action (providing more insulin), and the same glucose-lowering effect can usually be achieved with a modestly higher dose of insulin alone.

Does sulfonylureas reduce insulin resistance?

Prolonged sulfonylurea administration decreases insulin resistance and increases insulin secretion in non-insulin-dependent diabetes mellitus: evidence for improved insulin action at a postreceptor site in hepatic as well as extrahepatic tissues. Diabetes Care. 1984 May-Jun;7 Suppl 1:89-99.

Do sulfonylureas destroy beta cells?

1), increased pressure on the beta cell to secrete more insulin, whether induced by obesity/insulin resistance or chemical means (e.g. sulfonylureas), may cause beta cell death.

What is the role of sulfonyl urea?

Abstract. The sulphonylureas act by triggering insulin release from the pancreatic beta cell. A specific site on the adenosine triphosphate (ATP)-sensitive potassium channels is occupied by sulphonylureas leading to closure of the potassium channels and subsequent opening of calcium channels.

What effect do sulfonylureas have on insulin release?

Sulfonylureas and meglitinides directly stimulate release of insulin from pancreatic beta cells and thereby lower blood glucose concentrations. Because they work by stimulating insulin secretion, they are useful only in patients with some beta cell function. Adverse effects may include weight gain and hypoglycemia.

Do sulfonylureas increase insulin sensitivity?

Moreover, sulfonylureas seem to exert other effects as well: they increase peripheral glucose utilization by two mechanisms of action, by stimulating hepatic gluconeogenesis, and by increasing the number and sensitivity of insulin receptors [15].

How do sulfonylurea drugs increase insulin secretion?

Sulfonylureas are widely used to treat type 2 diabetes because they stimulate insulin secretion from pancreatic β-cells. They primarily act by binding to the SUR subunit of the ATP-sensitive potassium (KATP) channel and inducing channel closure.

Drugs that increase the effectiveness of sulfonil urea in reducing blood sugar levels. Non - steroidal anti - inflammatory drugs. Contraceptive pills. Some antifungal drugs

Non-steroidal anti-inflammatory drugs (NSAIDS) - such as salicylate, sulfa compounds, and warfarin - remove sulfonylurea drugs and increase their concentration in the blood and cause a sharp drop in blood sugar.
The second-generation sulfonyluria drugs are distinguished from first-generation drugs by not associating them with blood proteins.
Thus, a dramatic drop in blood sugar levels due to drug interactions with blood proteins is rare with second-generation sulfonylurea.
- Estrogen-containing pills can increase the effect of sulfonyluria drugs in a severe drop in blood sugar level.
Some antifungal drugs such as fluconazole and antibiotics such as chloramphenicol can lead to a severe hypoglycemia when used with sulfonyl urea drugs.
This is caused by the inhibition of sulfonyluria urea by these drugs and also by competing with blood proteins or with the output .
- Antihypertensive drugs can increase the risk of hypoglycemia when used with sulfonyl urea drugs.
- When using alcohol with sulfonyl urea drugs, this increases the risk of a severe drop in blood sugar.

Possible side effects of sulfonyl urea drugs .. Acute drop in blood sugar. overweight. Blood poisoning. Reservation of water in the body

Sulfonyl urea drugs are usually tolerated by patients well. Side effects include:
- Severe drop in blood sugar.
 Although sulfonylurea is less dangerous than insulin, it may cause a severe drop in blood sugar, but this severe drop in blood sugar from sulfoniluria may be prolonged and at the same time dangerous to the patient.
When you start using sulfonil urea, the risk of hypoglycemia is greater in the first few days and up to the first four months of use.
It is therefore important to emphasize that the patient should be aware of the level of sugar in the blood during this period.
It is also necessary to ensure the level of sugar in the blood continuously when practicing sports and increase activity or in the absence of taking the meal.
Patients should be alerted to the importance of eating breakfast, lunch and a snack before bedtime. Failure to eat or delay a meal can lead to a severe drop in blood sugar.
The risk of severe hypoglycemia from the use of second-generation sulfonylurea, such as glymaride, is equivalent to 1/10 that is updated by first-generation sulfonylurea.
- Weight gain causes increased appetite to eat and this is not desirable in obese patients with diabetes.
- These drugs may occur redness of the face, especially when using chlorampramide with alcohol.
- Chlorobramide can cause water retention in the body.
It is similar in effect to the hormone Vasopressin inhibitor for urination.
This leads to low blood sodium level and the occurrence of water poisoning.
- Occurrence of septicemia is rare and may occur in less than 1% of patients.
- These drugs can cause a slight risk to the heart.
- Nausea and metallic taste or change in taste in 1-3% of patients.
The drugs that compete with the centers of the association of sulfonyl urea drugs with blood proteins, or drugs that affect their metabolism in the liver can interact with sulfonylurea drugs and increase or Resists its anti-sugar effect.

Mechanism of action of sulfonyl urea drugs .. Alert the secretion of insulin from beta cells in the pancreas. Reduce Glucagon concentration in the blood

Sulfonyluria, either first-generation or second-generation, works primarily by alerting the insulin secretion of beta cells in the pancreas.
Therefore, these drugs have no place in the treatment of patients with type I diabetes, or diabetics who depend on their treatment on insulin.
For these drugs to work successfully, about 30% of beta cells are needed in a healthy state. These drugs are therefore useful in the early stages of type 2 diabetes.
For sulfonil urea to work well, it is preferable to use them at the same time daily.
They can be used with metformin or with thiazolidine dion drugs.
Short acting drugs such as gliboride and glybizide are usually taken twice a day, before breakfast and dinner.
Long-acting medications can be taken once a day, either before dinner, when you notice a high blood sugar level at bed time, or before breakfast when there is good care to monitor your blood sugar level during the day until the daily dose is confirmed.
All sulfonylurea drugs, whether they are first or second generation, work the same way to lower the level of sugar in the blood.

The second generation of sulfonyl urea drugs .. Caution in patients with heart disease or in elderly patients

Strongly used second-generation sulfonil urea drugs such as gliboride, glybizide, and glymaride should be used with caution in patients with heart disease or in older patients who are at higher risk for severe hypoglycaemia.
Diabetics with type 2 diabetes who did not respond to treatment using tulipiotamide or tulazamide may respond to treatment using the stronger first-generation drugs of sulfonylurea (such as chlorpromamide) or a second-generation drug.

Contraindications to the use of sulfonyl urea medicines .. Type 1 diabetes. Failure in liver and kidney function. Sensitivity to sulfa compounds

Patients with type 1 diabetes.
- Patients with liver and kidney failure.
- Sensitivity to sulfa compounds.
- It is not recommended to use these drugs in nursing women or during pregnancy.
And not to use these drugs during pregnancy not only because these drugs may cause birth defects of fetuses, but may not lead to a reduction in blood sugar level as desired in pregnant women.
In addition, these drugs can pass through the placenta and may cause a severe drop in blood sugar in the fetus.
Insulin is usually used to control the level of sugar in the blood during pregnancy as it is a natural and safe hormone and does not result in congenital malformations of the fetus.
- Patients with severe stress.

Failure of sulfonyl urea drugs and non-response to the body .. Failure in the response of beta cells in the pancreas

The failure of sulfonil urea drugs to continue to maintain a good response to these drugs at the beginning of their use is considered to be one of the disadvantages of sulfonil urea in the treatment of the second type of sugar.
Although the inability to regularly maintain a diet may be responsible for many cases, it is likely that the use of multiple doses that result in elevated levels of long-acting sulfonylurea drugs may result in a lack of response to beta cells in the pancreas.

Reducing the concentration of glucagon in the blood with sulfonyl urea drugs and increasing the release of both insulin and somatostatin

The use of long-term sulfonyluria drugs in patients with type 2 diabetes leads to reduced glucagon levels in the blood, and this may contribute to lowering blood sugar by these drugs.
The mechanism of action of these drugs to reduce glucagon levels is not entirely clear, but this may be due to an indirect effect by increasing the release of insulin and somatostatin, which in turn inhibit the secretion of cells in the pancreas (A cells).
In the absence of beta cells, as in patients with type 1 diabetes, as well as in experimental animals who have diabetes using streptozacin, sulfonyluria drugs actually lead to a slight increase in glucagon secretion.

Alert insulin secretion of beta cells in the pancreas by sulfonyl urea drugs and prevent the release of potassium ions

This mechanism is the basis for the work of all sulfonil urea drugs. Insulin secretion is stimulated from beta cells by combining these drugs with receptors on beta cells.
The combination of these drugs in this way prevents the release of potassium ions through the channels, resulting in the disappearance of polarization depolarization.
This in turn opens the calcium channels and leads to the entry of calcium and the release of insulin ready from within the cells.
The theory confirms that these drugs are ineffective in patients who lack the presence of insulin or even animals in which beta cells were destroyed using the chemical alloxan.

SULPHONYL UREA COMPOUNDS. TOLBOTHAMIDE AND CHLORBROPAMIDE FOR REDUCTION OF HYGIENE AND THE TREATMENT OF TYPOID DISEASE

These drugs were discovered by accident after it was observed that sulfa anti-bacterial drugs, which were used to treat typhoid disease, caused a decrease in blood sugar in patients.
Many sulfonylurea drugs were then constructed by altering the chemical form of sulfa and are still used today. The first two drugs were used to treat type 2 diuretics, thulbiotamide and chloropropamide.
All sulfonyl urea compounds, either first or second generation, share the same basic chemical structure as sulfa, so patients who may be allergic to sulfa will have the same degree of sensitivity to sulfonylurea.

Advantages of oral sulfonyluria medications compared to insulin injections

1 - easy to give medicine - since the administration of oral sulfonyl urea drugs is undoubtedly easier and less expensive than giving insulin by injection.
2 - giving oral sulfonyl urea drugs alert insulin secretion of beta cells in the pancreas and so it is similar to scientific physiological in that the insulin released from the pancreas by these drugs first reach the liver and affects the exit of glucose from the liver.
Conversely, insulin given by injection will result in the accumulation of insulin in the peripheral tissues before reaching the liver.
3. Sulfonyl urea drugs are less likely to cause insulin sensitivity than insulin given by injection, especially from animal sources or persons with anti-insulin agents.

Effectiveness and safety of sulfonyl urea drugs. Increased risk of death from heart disease due to use of these drugs

A report from the University Group Diabetes Program in 1970 showed an increase in the number of heart disease deaths in diabetics treated with tulipiotamide compared to those treated with insulin injections.
There is still a contradiction to this day about the validity of this conclusion because there are observations on the design of the study.
Thus, the relationship between the death of patients due to heart disease and sulfonylurea drugs has not been demonstrated by clear and strong evidence.
For this reason, sulfonylurea is still widely used to treat patients with type 2 diabetes. However, in 1984, the Food and Drug Administration (FDA) obliged manufacturers of sulfonylurea drugs to write a warning about the increased risk of death from heart disease as a result of their use.
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