Blood Sugar 101 by Jenny Ruhl

Author:Jenny Ruhl
Language: eng
Format: epub
Publisher: Technion Books
Published: 2015-12-21T05:00:00+00:00

The UKPDS 10 year follow-up study also shows that sulfonylurea drugs are a poor choice compared to metformin. It found that patients in the Sulfonylurea-insulin group had only a 9% risk reduction in any diabetes-related endpoint compared to the 21% risk reduction experienced by those taking metformin. Their risk of death due to diabetes was reduced by only 17% compared to the 30% risk reduction seen in those taking metformin.

Since gliclazide, the one safe sulfonylurea drug, is not sold in the United States, the only safe choice for Americans who need a drug that stimulates insulin production is repaglinide.

Combining Insulin Stimulating Drugs with Others Causes Hypos

The FDA has issued updates to the prescribing information for glimepiride and other sulfonylureas as well as for repaglinide, warning that their blood sugar lowering effect may be magnified when they are taken with other medications that slow their removal from the body. This may allow them cause dangerous hypos.

The drugs that were already known to interact with sulfonylureas are: nonsteroidal anti-inflammatory drugs (Motrin, Advil, and Ibuprofen), clarithromycin, and other drugs that are highly protein bound, such as salicylates (aspirin and salsalate), sulfonamides antibiotics (Bactrim/Septra), chloramphenicol, coumarins, probenecid, monoamine oxidase inhibitors, and ß-adrenergic blocking agents.

To this list the FDA has added disopyramide (Norpace), fluoxetine (Prozac), and the quinolone antibiotics (Cipro, Noroxin, Levaquin etc.), all of which also potentiate the effects of sulfonylureas.

The warnings for repaglinide now include gemfibrozil (Lopid) and the immune suppressor cyclosporin.

Because doctors aren’t always aware of these drug interactions, if you are prescribed any of these insulin stimulating drugs, check with your pharmacist to make sure that you aren’t taking another drug that could make you more likely to suffer dangerous hypos.

Combining Repaglinide with Metformin Can Amplify its Impact

Combining repaglinide with metformin can greatly amplify the impact of both drugs on blood sugar. The Prandin Prescribing Information reveals that over a 4-5 month period, people taking repaglinide alone saw their fasting blood sugar rise by an average of 8 mg/dl while people taking metformin alone saw an average drop in their fasting blood sugar of 4.5 mg/dl. But people taking both drugs simultaneously experienced an average decline in fasting blood sugar of 39.2 mg/dl—almost ten times as much as with metformin alone!

In addition, some people taking repaglinide (including myself) have found that over time it can wear away the body's ability to raise blood sugars when they drop too low, resulting in the sudden onset of frighteningly low hypos. After 6 months of taking repaglinide and metformin without incident I experienced two hypos in the 40 mg/dl range within one week, though I had not changed my diet or dose. I have heard similar stories from others. If you see your fasting blood sugar dropping below the 80s while taking repaglinide, it may be time to lower your dose or to take a “drug vacation” for a few weeks to avoid experiencing dangerous hypos without warning.

Do Insulin Stimulating Drugs Cause Beta Cell Burnout?

There is some question about the wisdom of forcing already dysfunctional beta cells to produce yet more insulin.

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