Dr. Ahmet Ergin almost never recommends diabetic medicines such as Glipizide, Glyburide, or Glimepiride (sulfonylureas) to type 2 diabetic patients unless there are no alternatives. Glipizide, Glyburide, or Glimepiride will cause weight gain, low blood sugar(hypoglycemia), and pancreas failure in time. As a result, patients end up taking insulin sooner. What are the alternative diabetic medications to sulfonylureas?
Hey guys this is dr ahmet ergin welcome to sugar md’s today we are going to talk about sulfonylureas glucoside glutabright glyburide the most commonly prescribed medications and we’re going to touch base startups and branding we’re going to talk about the differences between suffering urea class glp1 class and insulin sensitizers so tune in and if you like
This video do not forget to give it thumbs up and subscribe and welcome to sugar md’s today i’m going to talk to you about some of the medications that you guys have been pro uh prescribed quite often and the topic is the sulfonylureas so sulfonylureas most commonly are gallipozide kilometer pride and glyburide and megalithinite is almost like a subgroup of
Sulfonylureas and these are like starlights which is not the glenoid and the prawndine which is replicanide now why we are talking about cell phone euro yesterday because they are very inexpensive they are widely available they are the most commonly prescribed medications so the most commonly prescribed medications that does not necessarily mean they are the best
Medications so we are going to talk about what they do why they are not the best medications and what are the alternative medications out there that you can consider now of course the best medication is no medication so if you can manage your diabetes at the early stages hopefully with no medication with diet and exercise that will be the the best scenario but
Should you need a medication i want you to be on a medication that you will get the most benefit and the least side effects now the theory behind the suffering sulfonylureas the way they work is that they actually make your body produce insulin so they basically go to your pancreas and in pancreas there are cells called beta cells the beta cells are stimulated
By sulfonylureas now this first group if you call them sulfonylureas are longer acting and magnetized are shorter acting which are starlets and pronted now the problem with cell phone areas is you have to take it early in the morning before the breakfast and if you don’t have a breakfast that’s a problem because immediately after you take glucoside for example
Your insulin will go from here to here now you can see the problem right this is not much different than just taking an insulin shot now people think that when they take pills that is mild or that’s okay or that’s not a big deal you can get away with things but that’s not true especially with sulfonylureas if you take that pill you have to eat now the problem
Is we tell diabetics not to eat but then we give a pill and tell them to eat and if you tell them actually eat well because if you don’t eat well your blood sugar may go down now that is a problem right don’t you think so i mean uh now of course what happens when you tell people go eat of course they’re gonna gain weight and we tell people to lose weight and we
Give medications that they’re gonna end up gaining weight now also we tell people not to have low blood sugars but this is the best remedy to have a low blood sugar because as i said your insulin level will go up right away and if you didn’t have any food then that is a problem now what are the problems we are experiencing here if you have a kidney problem all
These medications are excreted by kidneys okay so people are scared of metformin thinking that the metformin causes kidney damage there is no data whatsoever in this earth that that says metformin causes kidney damage there is data that says the metformin can accumulate when somebody has chronic kidney disease that is advanced enough and then that there is a slight
Risk of metabolic acidosis and so forth so we stop the metformin but the problem is uh people are misinformed and they don’t really hear from real doctors they end up hearing from sources like internet and so forth um and they end up believing that the metformin is causing the kidney failure which is not true but in this case actually similar to metformin these
Medications can accumulate and even in the early stages of kidney failure the glucoside glycopyride and glyburide can accumulate in your system so what does that mean if you are taking these medications and if they are accumulating in your system if you end up having a low blood sugar it’s going to be very hard to get out of that blood sugar it’s like someone is
Infusing insulin through your iv lines because these are staying in your system they are not cleared because of your kidney dysfunction and you are going to end up having insulin production constantly so i have seen many cases of patients in the hospital under iv glucose infusion for like two three days because they were taking these sulfonylureas now uh you may
Have been prescribed cell phone urease just recently or you have been using cell phone uris for a long time a lot of people can still use cell phone ureas just fine uh but it does not mean that they are the best medications right so um another big theory about the cell that ph believed that something urease can actually kill your pancreas so that is uh a theory
It is not 100 percent proven but when they did studies comparing certain urias with for example insulin sensitizers metformin or pioglitazone when they compared sulfur areas to these insulin sensitizers patients who were taking cell phone areas ended up needing insulin way faster so that means that if you’re on cell phone areas you may end up with insulin faster
Now again you may have been on cell phone ureas for 20 years and you may say hey you know i ain’t eating so and still but i’m not talking about specific cases you’re talking about studies you’re talking about you know genital population again everybody is different but generally let’s say to make it simple if you put hundred people on saturdays okay so 10 people
May just do fine and they may never need insulin okay so 50 people will probably need insulin within 5-10 years and maybe another 40 people will end up needing insulin within a few years so that is what i’m talking about so your case may be different but the studies indicate that these agents can end up actually straining your beta cells now why is that so think
About this if you’re already tired right you personally you’re tired and your boss comes with a whip and says work work work oh you can you’re going to lose your job if you don’t work more and so forth so southern areas are just like a whip on your pancreas so you are whipping somebody who’s already tired you’re whipping them to work harder what’s gonna happen
They’re gonna end up falling dead right so that’s what happens to your beta cells guys so when you constantly make your beta cells work because these guys are going and sitting like literally sitting on your beta cells and asking them to constantly work as a result your insulin levels constantly are high you’re constantly hungry and the moment you skip a meal bam
Your blood sugars are down and you’re in trouble so why sometimes we use uh as megalithinites because they’re shorter acting but they pretty much do the same thing instead of whipping your pancreas 24 7 they’re whipping your pancreas for you know seven to eight hours they are so problematic they are kind of still expensive to be honest with you i know why they
Are generic and expensive that doesn’t make any sense uh but they still cause weight gain they can still cause low blood sugars it’s just shorter acting so they’re going to give you a shorter trouble time than a longer travel time now what are our alternatives so if you’re in a strong philly urea and if you want to move on to another agent what would you choose
Now as doctors we use metformin of course in appropriate patients not everybody is a candidate for it payable to zone is another agent which is not super popular nowadays but i think it’s still a good agent to use there are some there are some caveats to paya guiltazone when you choose the right patient which i’m not going to go into secret detail about every
Drug because the topic today is cell phone urease and acorbose which is pretty close um is another agent that can be used now a carbon is not an insulin sensitizer it’s an alpha glucose glucosidase inhibitor and what it does it basically does not let you absorb glucose or let’s see but it’s going to be it’s going to have a much slower rate so that allows the
Insulin um production uh the needs much less now of course another class glp one class in the last 10 years they came to the market um now there’s a lot of good things about glp ones there is really the study so far does not say anything too negative about glp1 class because they do everything that we want a medication do uh what do we want from our medication
We want the medication to stimulate your beta cells only when needed so you don’t want to tell your beta cells to constantly work they just need to work when you eat when you need insulin bonus then this agents do that they also slow down your absorption so your glucose is not going to rush to your intestinal system into your blood which will require insulin
Secretion and if you don’t have that enough then you’re going to have a blood sugar spike the glp one class yeah in this class again we have ozempic rubelsus victoza bibari and bioeta truly etc but this class will slow down your absorption which is another good thing now what is the third good thing about the glp one class is it is going to suppress your appetite
Now did you pay attention to something glp one class does exactly the opposite of cell phone ureas does now they portray this to blood sugar but in a much different way so some of these agents are actually most of these agents in glp one class are basically injections now there has been some resistance on the patient side especially in primary care world um
Because patients don’t want to take injections injections is just a taboo people associate injections with insulin although you know we try to explain that these are not insulin at all these they just make your body produce its own insulin etc but they still have trouble understanding that’s why i’m here because i don’t think your doctor will take that much time
To explain all these things to you so you can make the right choice and as a patient i don’t want you to go search on the internet and call the helpline.com or webmd.com and try to make your own decision not a good idea so again back to glp once remember remember the southern areas constantly secrete your insulin glp ones only when you need the insulin softened
Urease make you hungry glp one class makes you feel full your appetite goes down saphenous makes you gain weight glp one class make you lose weight now there are some really neat mechanisms behind glp1 class so what are they now number one yes but the cells are stimulated only when needed but also there is alpha cells in your in your pancreas and alpha cells are
The glucagon screening um the the cells now glucagon is exact opposite of insulin so why do we need glucagon because if your blood sugar is plummeting glucagon is the mechanism that comes into play to save you from a severe low blood sugar and the problem is in patients with diabetes there is a dysregulation glucagon is paradoxically screeded when your blood
Sugars are high remember glucagon is only excreted or is supposed to be secreted when your blood sugars are low but in diabetics because of the loss of feedback between insulin and glucagon your glucagon will go up when you eat now that is a huge problem uh although people don’t talk about it but there’s a huge problem now as a result your blood sugars are going
To have hard time coming down even if you make insulin now if your doctor tests your insulin or c peptide and so forth they are going to come back just fine and you’re going to be like okay well if i’m making insulin why is it not coming out yeah they’re going to say you’re insulin resistant but yeah that’s a simple answer but there are actually more to that there
Are a lot of other hormones are involved glucagon is one of the main ones now glp1 class will reduce that glucagon so as a result you’re not going to have this paradoxical blood sugar spike after you eat okay so uh most importantly like we discussed with cell phone urias guys southern ureas are basically squeezing the truth of your beta cells or whipping your
Beta cells to death glp1 class on the other hand actually studies show that when you use glp1 class your beta cells will increase even in number actually prolong your beta cells it’s going to prolong your time to go to insulin and that’s very very important because what we don’t want to do is to put our patients on insulin so another very interesting study that
I want to point out uh which was a study that was done uh uh by sema glutathione molecule for ozanpic and rebels they are the same molecule ozone because the injection rebels as a pill form but what was interesting i’m going to show you here in this graph so when they looked at the placebo group which is the diabetic patients who did not get the semiglottid their
Insulin response in time was just like this now i’m going to show you the normal group the normal the normal people who do not have diabetes their insulin response was just like this to uh a um you know food intake so what happened after uh i think 12 weeks of semi glow tide diabetic patients again this red line is the normal people this this green line here
Is diabetic patients who do not take a semicolotide and what happened was patients who start taking diabetic patients who start taking semogulatide their insulin response became almost identical almost identical to patients who do not have diabetes now if you’re talking about diabetes cure or diabetes remission you can actually call that the diabetes remission or
Cure and i have a lot of patients coming down to avon zero five percent with the glp one class again uh these are the only downside of the glp one class unfortunately they are expensive but there are copays coupons etc that your doctors your pharmacists can help you to get very very good deals insulin sensitizers again metformin is free at publix payagultazone
Is very inexpensive medication as well a carbos also is very inexpensive the only problem with air carbons it’s a lot of gas or intestinal problems especially flatulence gassiness is a huge problem med terminal also has a lot of gastrointestinal problems which we will talk in another video um and the pioglitazone is a good agent doesn’t have an immediate side
Effects but sometimes especially in elderly female patients it can increase the risk of fractures if it is used for a prolonged amount of time um but other than that octo is fairly good agent there is there was some suggestion of a bladder cancer with octos but that was a very few in number uh so if you want to use a medication that is really not necessarily
Very expensive but can help your insulin sensitivity octals may be a good option easy to get confused on that again cell phone urea group uh we sometimes use it if you are totally desperate if the patient cannot afford anything else if um or sometimes they come to me and they say i’ve been using this forever and i’m fine i’m not gonna rock the boat right so i
Still mention other agents uh the benefits of other agents but if you’re happy with your medication and uh you have been fine then then fine because we treat patients we we don’t treat patients like numbers everybody’s response is different everybody is a different individual but i want you to be aware of the problems associated with cell phone ureas yes they
Bring your blood sugar down but they have a lot of other problems that go with it now i hope this video was helpful guys so if it was please give a thumbs up and please subscribe to our channel and we’ll see in the next video
Transcribed from video
Diabetic Drugs You Should NEVER take: Glipizide, Glyburide, or Glimepiride By SugarMD
