Treatment

Sulfonylureas and Beta Cell Burnout

Gretchen Becker Health Guide October 31, 2012
  • For years some diabetes authors have told us that the diabetes drugs known as sulfonylureas, often called just “sulfs,” would burn out our beta cells. Beta cells are the cells in the pancreas that produce insulin.   I’ve occasionally come across comments in research papers th...

12 Comments
  • spirit7
    Feb. 09, 2014

    As a MODY I am on both metformin (500mg x 4) and glimiperide (2 mg day). My endo added the sulfa drug because the metformin alone wasn't doing the job. I keep reading about beta cell burnout and heart issues from sulfa's but what are other options? I am also taking prandin 2 mg x 2) My AIC is good (5.2) and I do low-carb. Looking for different med options!

    ...
    RHMLucky777
    Read More

    As a MODY I am on both metformin (500mg x 4) and glimiperide (2 mg day). My endo added the sulfa drug because the metformin alone wasn't doing the job. I keep reading about beta cell burnout and heart issues from sulfa's but what are other options? I am also taking prandin 2 mg x 2) My AIC is good (5.2) and I do low-carb. Looking for different med options!

     

    • Gretchen Becker
      Health Guide
      Feb. 09, 2014

      Hi Spirit,

       

      There are different types of MODY, and best meds for each may differ. The best source of MODY information is Jenny Ruhl's page on MODY:

       

      http://www.phlaunt.com/diabetes/14047009.php

       

      She has one type of MODY herself and understands the frustration of patients when their doctors treat them like type 2s. One type is incredibly sensitive...

      RHMLucky777

      Read More

      Hi Spirit,

       

      There are different types of MODY, and best meds for each may differ. The best source of MODY information is Jenny Ruhl's page on MODY:

       

      http://www.phlaunt.com/diabetes/14047009.php

       

      She has one type of MODY herself and understands the frustration of patients when their doctors treat them like type 2s. One type is incredibly sensitive to the sulfs, which is probably why your doctor recommended that. One can also use tiny amounts of insulin.

       

      With both insulin and sulfs, the side effects seen in people with type 2 (weight gain and perhaps heart effects) are less likely in MODY because MODYs need such small amounts of both as insulin resistance is usually not the core problem.

       

      It sounds as if you're already doing quite well, so maybe your current regimen is fine. Was the A1c of 5.2 before or after you added the sulf?

       

      If the metformin isn't doing much, have you asked about dropping that?

       

      I'm not a doctor and I can't tell you what to do, and I don't know of any new drugs for MODY. Even if I did, it's often better to use older drugs that have a longer track record. Sometimes new "wonder drugs" turn out to have bad side effects when used for a long time.

  • Robin
    Nov. 01, 2012

    I started on Metformin when I was first diagnosed, but an extreme reaction combined with a history of ulcerative colitis nipped that in the bud. My numbers were high enough that when the docs prescribed Glipizide, I was soon up to 20 mg. Once I started reading up (including your book, thank you very much!) I decided the thing to do was cut carbs and lower my...

    RHMLucky777

    Read More

    I started on Metformin when I was first diagnosed, but an extreme reaction combined with a history of ulcerative colitis nipped that in the bud. My numbers were high enough that when the docs prescribed Glipizide, I was soon up to 20 mg. Once I started reading up (including your book, thank you very much!) I decided the thing to do was cut carbs and lower my dosage. I've now been low-carb for about 18 months, and for a year maintained an A1c of 5.5 at a dosage of 5mg of Glipizide. I'm hoping that will let the beta cells last a little longer.

     

    I'm often asked why I don't just go to insulin, but I figure that as long as I can make my own, why not use that? What am I saving it for?

     

     

    • Gretchen Becker
      Health Guide
      Nov. 02, 2012

      Robin, The reason to go on insulin before you absolutely need it is because if your beta cells are all gone, with some insulin production of your own remaining, you won't have the wild swings that can occur with no beta cells. Your own beta cells will act as a buffer. However, with your low-carb diet and good A1c's, your beta cells aren't being exposed to a...

      RHMLucky777

      Read More

      Robin, The reason to go on insulin before you absolutely need it is because if your beta cells are all gone, with some insulin production of your own remaining, you won't have the wild swings that can occur with no beta cells. Your own beta cells will act as a buffer. However, with your low-carb diet and good A1c's, your beta cells aren't being exposed to a lot of glucotoxicity, so it's probably not urgent for you to switch.

       

      And your bad reaction to metformin is a good reason to use a sulf.

       

      There's also the theory that "resting" your beta cells will let them recover a bit. On that theory, I went on Lantus for a year to see if my A1c would improve. It didn't: When I stopped the Lantus, the A1c was slightly higher than it had been before I started it. Since then, it's gone down again, but I didn't feel that "resting" my beta cells helped me, although maybe it did help the beta cells and they just took some time to gear up for production again. This is such a complex disease.

       

      Resting the beta cells might help someone else in a clearer way.

       

       

    • Gretchen Becker
      Health Guide
      Nov. 02, 2012

      Oops. I should proofread before hitting Post.

       

      "because if your beta cells are all gone, with some insulin production of your own remaining, you won't have the wild swings that can occur with no beta cells" should be "because when you decide to use insulin. . . " Obviously, if the beta cells were "all gone" they wouldn't have any significant insulin production...

      RHMLucky777

      Read More

      Oops. I should proofread before hitting Post.

       

      "because if your beta cells are all gone, with some insulin production of your own remaining, you won't have the wild swings that can occur with no beta cells" should be "because when you decide to use insulin. . . " Obviously, if the beta cells were "all gone" they wouldn't have any significant insulin production remaing.

    • Robin
      Nov. 02, 2012

      Thanks Gretchen. Food for thought. I love the freedom of not having to focus so closely on my BG numbers, and not having to balance insulin dosing against eating. I'm a grazer, so I don't know how I could handle bolus injections, but maybe if I could get away with just basal it wouldn't be so bad. I wonder if it makes a difference that I rarely eat enough carbs...

      RHMLucky777

      Read More

      Thanks Gretchen. Food for thought. I love the freedom of not having to focus so closely on my BG numbers, and not having to balance insulin dosing against eating. I'm a grazer, so I don't know how I could handle bolus injections, but maybe if I could get away with just basal it wouldn't be so bad. I wonder if it makes a difference that I rarely eat enough carbs (and very rarely the demanding kind) to make more than a 30-point bump in my BG.

       

      I appreciate all your advice. I wish there were some way I could force-feed your knowledge into all the new diabetics I see on my listservs, not to mention at my monthly self-care meetings. Oh boy, it's scary out there.

    • Gretchen Becker
      Health Guide
      Nov. 02, 2012

      Robin, I've mostly just taken a basal. It reduces my fastings and premeal numbers about 30 points, which means I'm 30 points lower at the postprandial peak. I keep R on hand, and if I'm higher than I like, I'll use a little of that. You can get R without a prescription.

       

      Like you, I go up about 30 to 40 points after eating, because I don't eat many carbs....

      RHMLucky777

      Read More

      Robin, I've mostly just taken a basal. It reduces my fastings and premeal numbers about 30 points, which means I'm 30 points lower at the postprandial peak. I keep R on hand, and if I'm higher than I like, I'll use a little of that. You can get R without a prescription.

       

      Like you, I go up about 30 to 40 points after eating, because I don't eat many carbs.

       

      Yes, it's sad how many people with type 2 really don't alter their eating patterns much. But we can't help people who don't want to be helped, just as no one can help someone with an alcohol problem until they decide they want help.

    • Robin
      Nov. 02, 2012

      It's so darn complicated it makes my head spin. My endo offered me Levemir and also suggested Victoza, both before I drastically cut carbs and halved my A1c last summer. Since then he's been suggesting I quit the Glipizide altogether, but I know I can't keep my levels where I want them without some help.

       

      The idea of adding a basal insulin just makes...

      RHMLucky777

      Read More

      It's so darn complicated it makes my head spin. My endo offered me Levemir and also suggested Victoza, both before I drastically cut carbs and halved my A1c last summer. Since then he's been suggesting I quit the Glipizide altogether, but I know I can't keep my levels where I want them without some help.

       

      The idea of adding a basal insulin just makes me fear lows, because I can't count on myself to eat regularly or to remember to check before I go out. But then I wonder if it won't be any worse than taking an OHA anyway.

       

      Rats, inaction is so easy! Saying "mañana" is so much easier than tackling the issue today!

       

       

    • Gretchen Becker
      Health Guide
      Nov. 03, 2012

      Robin, I can't give you medical advice, tell you what you *should* do but, when discussing with your doctor, you should know that both sulfs and insulin can cause lows for the same reason: if you take the wrong dose you'll have too much insulin.

       

      Your doctor suggested giving up the sulf. Next time you see the doctor, ask if you could stop the sulf and...

      RHMLucky777

      Read More

      Robin, I can't give you medical advice, tell you what you *should* do but, when discussing with your doctor, you should know that both sulfs and insulin can cause lows for the same reason: if you take the wrong dose you'll have too much insulin.

       

      Your doctor suggested giving up the sulf. Next time you see the doctor, ask if you could stop the sulf and then go back on it if your BGs go up too much.

    • Robin
      Nov. 03, 2012

      I tried that briefly - even tried 2.5 mg/day, but I'm not yet at the point where I can control my eating well enough, and I didn't like my new numbers (went up about 20-40 points when on no meds, which isn't lethal but still not good). I freaked out when I saw that first reading of over 160.

       

      On the other hand, having glucose-rich blood was kind of a...

      RHMLucky777

      Read More

      I tried that briefly - even tried 2.5 mg/day, but I'm not yet at the point where I can control my eating well enough, and I didn't like my new numbers (went up about 20-40 points when on no meds, which isn't lethal but still not good). I freaked out when I saw that first reading of over 160.

       

      On the other hand, having glucose-rich blood was kind of a high I'd been missing!

       

      I may experiment with something new next time I see my endo. I'll let you know what happens.

       

      PS if you have any strong opinions about counting carbs, I'd love to see you write an article about it. I see so many opinions (carbs v fiber v sugar alcohols). Thanks!

  • Aggie
    Nov. 01, 2012

    It is just possible that none of the drugs for type 2 do anything but temporarily lower the numbers. No study, including ones almost revered as Holy Writ, has ever demonstrated that the hypoglycemic drugs do anything to affect the long-term complications of diabetes. These studies have been manipulated to show some benefit, and it is what all studies are based...

    RHMLucky777

    Read More

    It is just possible that none of the drugs for type 2 do anything but temporarily lower the numbers. No study, including ones almost revered as Holy Writ, has ever demonstrated that the hypoglycemic drugs do anything to affect the long-term complications of diabetes. These studies have been manipulated to show some benefit, and it is what all studies are based on now - just lowering the numbers. It will be a few more decades before we know what effect, if any, these drugs have on the long-term complications of the disease.

    • Gretchen Becker
      Health Guide
      Nov. 01, 2012

      Aggie, It is true that we can never be 100% sure of long-term effects of anything. Unfortunately, this argument is often used to dismiss evidence we don't want to hear.

       

      For example, how do we know what the long-term effects of eating fish or broccoli are?

       

      It is very likely that these drugs, as well as other drugs like insulin, simply lower BG...

      RHMLucky777

      Read More

      Aggie, It is true that we can never be 100% sure of long-term effects of anything. Unfortunately, this argument is often used to dismiss evidence we don't want to hear.

       

      For example, how do we know what the long-term effects of eating fish or broccoli are?

       

      It is very likely that these drugs, as well as other drugs like insulin, simply lower BG as long as you take them. But we know that lower BG is associated with lower rates of complications. So lowering BG and reducing risk of complications while you try to find another regimen, for example, losing weight, that will help you control with less or no drugs makes sense.

       

      Not everyone can find a way of dealing with diabetes without drugs. Most people don't want to wait 50 years until the perfect study is done, especially if they go blind while waiting.