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Meds that kills beta cells

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#1
Dan Gato

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I've read that Sulfonylureas meds such as Glipizide, Glyburide kill the beta cells of the pancreas over a period of time.

Have you read or do you know at what dosage this start to happen?
Also, over what period of time?

This is something that I have had in my mind for a few months now. and would benefit people taking Glipizide, Glucotrol, Amaryl; to decide wether or not continue taking any of these meds, or at least talk to the doc about it.
Latest A1C
Aprl '10...5.8
Feb '09 ..5.4
Aug '08...5.2
Feb '08...5.5
Dec '07...5.2

#2
slipperyelm

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I don't think it is a matter of dosage, as sulfonlylureas are not directly toxic to the insulin producing cells.

I don't think I can give any kind of satisfying answer though, as I do not know the mechanism of beta cell exhaustion.

For me personally, after having used one for a year, I HATE SULFONYLUREAS. Moreover, I love my beta cells and would rather keep them alive and functioning as long as possible. Therefore, I make other efforts to control my BG levels, efforts that do not leave me unable to put in a good day's manual labor when I need to, as the sulfonyl' did. Efforts that do not cause hypoglycemia several times a week (or even day) as the sulfonyl' did. Efforts that do not cause me to have to over consume calories to beat back a hypo, as the sulfonyl' did. Efforts that do not cause me to have to have the glucose meter with me everytime I leave the house for 15 minutes, as the.... Efforts that do not make me have to take glucose tablets with me everywhere I go, as the....

#3
Harold

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What your talking about is commonly referred to as beta cell burnout. This can and does happen with and with out taking sulfonylreas, but has never been proved to be caused by the drug alone.

#4
slipperyelm

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I think it is supposed that the constant, chronic production of prodigious amounts of insulin that "burns out" the beta cells in Type 2. It can happen without any med at all as the body tries so hard to clear the glucose into the somatic cells. But sulfonylureas cause the pancrease to put out even more insulin. I think it is the non-stop work of very high amounts of insulin that is thought to cause beta cell burnout. If there is a medicine causing the beta cells to exude high levels of insulin around the clock, the cells never get a resting period, such as is normal in the non-diabetic body.

Still that is not really an explanation of the mechanism of burnout/exhaustion. There are many aspects of diabetes that have not been studied thoroughly, much as we wish they might have been.

#5
mike9876

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My doc wanted to put me on tabs to boost insuline production, she said it takes 7 years before beta cell burn out. I got her to put me on avandia and since being on avandia my numbers have improved way more than the doc thought they would.

I have read different reports avandia, on diabetes UK it said avandia protects the beta cells from burn out and another said when somebody is insuline resistant taking avandia will completely ward off type 2 from developing.

I am happy with avandia coupled with metformin. Even after over eating my numbers are good after a couple of hours. My last two tests BG was 5.3 and 5.8 both days I ate too much. Best reading 4.7 and 4.8 and those readings after I was naughty and had some sweet stuff. I do get a higher reading sometimes but its never above 9 and normally between 7 and 8.

When I was first dx I asked one my docs to put me on avandi and he said no because metformin was the first line treatment and wonder what would of happened if I had been on it when I was insuline resistant. There was a total lack of support when I had insuline resistance. All I was told eat differently and exercise more. Nothing about if I exercised and changed diet diabetes will be halted. I believe many type 2'S out there would never of developed diabetes if the right support was place.

I think since I have been avandia with having normal BG's most of the time my insuline production must of dropped and my beta cells are getting a rest.

#6
Dan Gato

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[quote name='mike9876']My doc wanted to put me on tabs to boost insuline production, she said it takes 7 years before beta cell burn out. I got her to put me on avandia and since being on avandia my numbers have improved way more than the doc thought they would.

Mike, wow, beta cells burn out happen in 7 years that is a short period of time.
It was good that you were prescribed Avandia.
What are the other people with D to do? if they are taking Glipizide, Amaryl, etc.

No wonder people call D a progressive condition.
Latest A1C
Aprl '10...5.8
Feb '09 ..5.4
Aug '08...5.2
Feb '08...5.5
Dec '07...5.2

#7
princesslinda

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Here is some information from Dr. Bernstein's book "Diabetes Solution." Whether you ascribe to his way of eating, it is an interesting read and it does make sense IMO.

"If diet and exercise are not adequate to bring your blood sugars under control, the next level of treatment to consider is oral blood sugar–lowering medication, commonly known as oral hypoglycemic agents (OHAs).

There are three categories of OHAs, those that increase sensitivity to insulin, those whose action resembles that of insulin, and those that provoke your pancreas to produce more insulin. The first group is known as insulin sensitizers (or ISAs, for insulin-sensitizing agents); the second are the insulin mimetics (or IMAs, for insulin-mimetic agents), which act like insulin but do not build fat. Finally, there are the original OHAs, like sulfonylureas.

I only recommend the insulin sensitizers and insulin mimetics, for reasons that will become plain in short order. (Some drug companies have combined the old OHAs with insulin sensitizers, a move I strongly challenge. Tell your doctor you do not want any product containing an agent that works by causing the pancreas to make more insulin. This includes the old sulfonylureas and the new, similar drugs called meglitinides.*) For people who still have sufficient insulin-producing capacity, insulin sensitizers alone may provide the extra help they need to reach their blood sugar target. Some insulin-resistant individuals who produce little or no insulin on their own may find a combination of insulin sensitizers and insulin mimetics useful in reducing their doses of injected insulin.

*In addition to causing beta cell burnout, sulfonylureas also impair circulation in the heart and elsewhere by closing ATP-sensitive potassium channels that relax blood vessels.
There are three ISAs currently on the market, and at this writing I prescribe all three of them—metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos). Another, troglitazone (Rezulin), was taken off the market by its manufacturer in March 2000 because of the potential for causing liver damage. Rosiglitazone and pioglitazone have similar effects upon blood sugar but do not, apparently, have significant adverse effects upon the liver.

A note: Since brand names vary from country to country, I will use only the generic names in my discussion of these drugs.

Most of the OHAs on the market are not insulin-sensitizing or -mimetic. Instead, they provoke the pancreas to produce more insulin. For several reasons, this is considerably less desirable than taking a medication that sensitizes you to insulin. First, the pancreas-provoking OHAs can cause dangerously low blood sugar levels (hypoglycemia) if used improperly or if meals are skipped or delayed. Furthermore, forcing an already overworked pancreas to produce yet more insulin
can lead to the burnout of remaining beta cells. These products also facilitate beta cell destruction by increasing levels of a toxic substance called amyloid. Finally, it has been repeatedly shown in experiments— and I have seen it in my own patients—that controlling diabetes through blood sugar normalization can help restore weakened or damaged beta cells. It makes absolutely no sense to prescribe or recommend agents that will cause them renewed damage. In a nutshell, pancreas-provoking drugs are counterproductive and no longer have any place in the sensible treatment of diabetes."

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.





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