Sulphonylureas are older-generation diabetes drugs. They formulaically stimulate the secretion of insulin from the pancreas.
Sulphonylureas are used to manage type 2 diabetes in adults as a phase two or three medicine together with lifestyle management and metformin or other blood sugar-lowering medicines or basal insulin. They can also be used on their own, if metformin or other blood sugar-lowering medicines are not suitable.
In Finland, the use of sulphonylureas tablets has become significantly less common, with new pharmaceutical products becoming available. In Finland (7/2023), there is only one sulphonylurea product in use: glimepiride or, subject to a special permit, glibenclamide.
Sulphonylureas attach themselves to the receptor of the pancreatic beta cell, directly and formulaically increasing the secretion of insulin from the pancreas for the entire 24 hours.
Long-acting glimepiride lowers the blood sugar level after a meal as well as the fasting blood sugar.
For some people, glimepiride stops being effective over the years. It has been suspected that the medicine itself may hasten the body’s inability to produce insulin, but there is no unequivocal proof of this.
In addition to people with type 2 diabetes, there is a specific user group comprised of children with diabetes arising from a rare inborn receptor mutation.
Glimepiride is a long-acting medicine, which stimulates insulin secretion and requires you to have regular meals and prepare for physical exercise.
The initial glimepiride dose is normally one 1–2 mg tablet in the morning. If necessary, the dose is increased every 1–2 weeks based on the blood sugar self-measurements and doctor’s instructions. The usual dose is 4–6 mg per day.
Usually, the dose is taken once a day before the first proper meal. If the breakfast is light, the medicine is taken at lunch. Depending on the individual, the dose may also be divided into two portions.
A glimepiride user should learn to at least roughly estimate the amount of carbohydrates. A nurse cgives guidance on the carbohydrate counting. The medicine is long-acting and it requires a regular meal rhythm and an even amounts of carbohydrates in meals.
Sulphonylureas can cause blood sugar to go too low, if a meal is delayed or during exercise. This is why the meal times and quantities should be fairly regular day after day.
Sulphonylureas are not suitable in connection with an severe liver, kidney or heart failure. Due to the risk of low blood sugar, it is not suitable for the elderly. The product is not suitable if a person is allergic to sulpha.
All pharmaceutical products involve an individual risk of harmful side effects.
The most common and significant side effect of sulphonylureas is a too low blood sugar. It can be prevented by eating regular meals with regular amounts of carbohydrates and consuming additional food before exercise. This can easily lead to overeating, a fluctuating blood sugar level and weight gain. This is why sulphonylureas are no longer widely used.
Preventing low blood sugar when using glimepiride:
If your meal is delayed, eat a snack.
If you are exercising in the morning, you can wait until lunch before taking the medicine.
The amount carbohydrates in meals should remain fairly regular day after day.
Before exercise, you will need a small snack (containing approx. 20 g of carbs).
You can talk to your doctor about reducing the dose before long exercise sessions.
Take into account that heavy alcohol use increases the risk of low blood sugar.
