What Are Sulphonylureas?

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Sulphonylureas or Sulfonylureas are oral medicines for type 2 diabetes. Sulphonylureas work by stimulating your body’s natural insulin release and helping insulin work more effectively in the body. Sulphonylureas help to reduce blood glucose levels, improve diabetes control and protect against diabetes complications.

What Are Sulphonylureas?

Sulphonylurea is the name for a family of medications for diabetes.  Sulphonylurea tablets have been used extensively for the treatment of type 2 diabetes for around 50 years. Worldwide, they are still among the most used anti-diabetic drugs.

Sulphonylureas are classified into two generations. Gliclazide, glimepiride and glibenclamide are second-generation sulphonylureas and are currently prescribed for type 2 diabetes. Older, first-generation drugs include tolbutamide.

You may be prescribed a sulphonylurea for type 2 diabetes if you’re not overweight and can’t take metformin, if metformin is giving you unacceptable side effects, or if metformin alone isn’t controlling your blood sugars.

How do sulphonylureas work?

Sulphonylureas work by increasing insulin production in your pancreas and helping insulin work more effectively.

Sulphonylureas stimulate the beta cells to secrete insulin and slow down the clearance of insulin by the liver. The increased insulin concentration reduces blood glucose levels, improves your diabetes control and reduces the long-term complications of diabetes.

Because sulphonylureas increase your natural insulin secretion, they will only work if your beta cells are still active. Type 2 diabetes is progressive -your insulin production will slowly decrease over time. Sulphonylureas will not be effective if your pancreas can no longer produce insulin, and you may need to take alternative tablets or inject insulin.

All of the second-generation sulphonylureas are equally effective in treating type 2 diabetes and helping to control your blood glucose levels. However, the absorption, duration of action and dosing will vary between the different drugs.

Sulphonylurea tablets

Sulphonylureas are tablets to treat type 2 diabetes. Your doctor will prescribe them to be taken once or twice a day. You should swallow them, as instructed, with water just before a meal or as you start eating.

Benefits of sulphonylureas

When taken regularly, sulphonylureas can improve your diabetes control and prevent diabetes complications. The advantages of sulphonylureas include:

  • Sulphonylureas are inexpensive and widely available
  • The drugs are available in many different formulations, including slow-release tablets that reduce the risk of side effects and hypos
  • Sulphonylureas are usually well-tolerated by patients
  • There are combined formulations with other drugs like metformin, making it less complicated for people on multiple medications

Sulphonylurea side effects

Sulphonylureas are generally tolerated well. However, they are linked with complications. The disadvantage of sulphonylureas include:

Weight gain: Sulphonylureas aren’t recommended for people who are overweight or obese. Weight gain is a relatively common side effect of these drugs because of the increase in insulin production

Hypoglycaemia: Users are at increased risk of hypos or low blood sugar levels.  The risk is reduced with slow-release formulations and newer sulphonylureas like glimepiride. Hypos are more likely if you skip a meal, take place in strenuous activity or drink alcohol.

If you have a hypo, act quickly: eat fast-acting carbohydrates like jelly babies, dextrose tablets, cola or fruit juice. Let your diabetes team know if you’re having frequent hypos. They may change your dose or prescribe a different drug

Rash: Some people develop an itchy, red rash during the first 6-8 weeks of treatment. See your doctor if you are affected; you may need to swap to a different diabetes medication

Uncommonly you may experience:

  • Nausea
  • Diarrhoea
  • Constipation

Rare side effects include:

  • liver damage
  • Low numbers of blood cells, causing bleeding, bruising and a vulnerability to infections

If you have noticed unusual bruising, a yellow discolouration of the eye or skin, or you are worried about sulphonylurea side effects, see your GP, contact your diabetes team or call NHS 111

To find out more about effective diabetes medications, or to speak to one of our specialists at The London Diabetes Centre about prospective treatment options, get in touch today.

Sources:

https://www.diabetes.co.uk/diabetes-medication/sulphonylureas.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548036/

https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/sulfonylureas/

https://bnf.nice.org.uk/treatment-summary/type-2-diabetes.html

https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#drug-treatment-2

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