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
