Sulfonylureas Induced Hypoglycemia in Diabetics - A Review

Abstract

Diabetes is a metabolic disorder of glucose characterized by glucotoxicity, lipotoxicity and insulin resistance. In insulin resistance states, a higher level of insulin is needed to generate the usual body response to keep plasma glucose at physiologic level. The type 2 diabetics with insulin resistance cannot keep plasma glucose normal not because of absolute insulin deficiency but due to a relative deficiency as insulin is now required at a higher plasma level to achieve a near physiological or physiological plasma glucose level. Hence the need for a chemical agent to increase insulin secretion from the pancreatic beta cells at pharmacological dose (insulin secretagogues) was conceptualized and arrived at. Sulfonylureas are insulin secretagogues. Two generations of sulfonylurea's are in use. The first and second. The class effects of sulfonylurea include weight gain, allergic reaction and hypoglycemia. But not enough emphasis is placed on the severity and grading of the hypoglycemia complicating use of sulfonylureas. Meanwhile hypoglycemia induced by sulfonylurea use is of various degree, severity and duration. The classification of hypoglycemia into grades in ADEMOLUS CLASSIFICATION OF HYPOGLYCEMIA makes it easier for scientist to understand, compare and monitor the severity of sulfonylureas. Mrs KFO is a 67 years old diabetic diagnosed over 8 years ago. She had asymptomatic hypoglycemia with a glucometer reading low (ADEMOLUS PHENOMENON) on a clinic day visit. She had been on glimepiride for three years. Mrs A. F. is a 75 years old diabetic diagnosed 4 years prior to presentation. She had a glucometer reading of low during a random blood sugar check at 8pm on day 2 of admission with associated general body weakness. She was on metformin and glibenclamide. Mrs. I E is a 72 years old diabetic who had a glucometer reading of low during her outpatient clinic visit. She was on gliclazide. Sulfonylureas use has been shown by these cases to be associated with symptomatic and asymptomatic very severe hypoglycemia. A possibility of synthesizing a new equally potent third generation of sulfonylureas with minimal or no hypoglycemic effect should be looked into.

Gas Chromatography-Mass Spectrometry and In vitro Ethnopharmacological Investigations of the Solvent Ethyl Acetate Extract of Urtica dioica L. Leaf from Wokha, Nagaland, India

“…Chemical medications have been found to exhibit adverse effects. For instance, thiazolidinedione (TZD) has been associated with obesity and fat accumulation [26] . As such, scholars priorities the exploration of alternative medicinal sources, such as herbal remedies, that exhibit reduced adverse effects.…”

Aldose Reductase Enzyme's Clinical and Thermodynamic Characteristics in the Serum of Iraqi Diabetic Patients

“…Metformin or an insulin secretagogue called a sulfonylurea, which suppresses hepatic gluconeogenesis, are typically used as the first line of monotherapy [7]. These medications are frequently administered in combination when monotherapy fails [8]. Chronic hyperglycemia brought on by diabetes increases the generation of free radicals, notably reactive oxygen species (ROS), in all tissues as a result of protein glycosylation and glucose auto-oxidation [9][10][11].…”