An old reliable anti-diabetes drug

OUR Baguio doctors, specialists in endocrinology and diabetes arrived a few days ago from almost simultaneous international conference in Portugal and Denmark, all of them with some disturbing news, if the incidence of diabetes is still news. After all, the whole world has become "sweeter"- no pun intended with almost 450 million diabetics in 2020, and to think that number does not really reflect the real incidence of the metabolic disorder considering that in developing countries, there is under reporting of cases. The Western Pacific which includes the Philippines has the biggest pie of the diabetic cake with 170 million patients. Every 19 seconds, a new diabetic is diagnosed and for every wink of an eye- 6 seconds- a diabetic dies.

By now, with trimedia working closely together to spread awareness of the disease, the public now knows the microvascular complications; first to be felt are the neuropathic signs and symptoms- sensory deficits like numbness and tingling sensations of the distal extremities -fingers and toes- then later motor- weakness, and worse, autonomic dysfunction which make a lot of diabetic males depressed with their inability to have their usual hard-rock penile erection. In the Philippines, the number 1 cause of dialysis is chronic kidney failure, which for the most part is due to uncontrolled diabetes leading t nephropathy. And we are all convinced that cataract is not only caused by aging but also due to diabetes and if the retinopathy has gone worst, blindness sets in.

The macrovascular complications are affectations of the bigger blood vessels like the coronaries- blood supply of the heart, which first lead to diastolic dysfunction and later on to a myocardiao infarction- heart attack. Or the cerebral arteries could be affected thus stroke occurs. And you have heard of many amputations done on diabetics who may have started with a small wound or lesion but due to the impaired nerve and blood supply to the injured area due to the poor control of blood sugar, may have decreased the regenerative and healing process thus gangrene sets in and at this point, the doctors have no choice but to amputate to prevent the spread of infection to other parts of the body.

For many years, there are only three medicines for diabetes- the insulin of Best and Banting discovered in 1920s, the Metformins which is sill he preferred first drug of choice of the UKPDS and for DM Type 2 who don’t have to be on insulin, or for those who are sensitive to metformin who come down with disturbing problematic gastrointestinal upset not to mention the bitter lead-like taste, fortunately there is Sulfonylureas.

Your columnist is among the enthusiastic listeners to the lecture of Dr. Domingo Solimen, a true-blue Baguio boy, A Cordilleran lad, who after finishing among the creme de la creme of SLU Medicine, spent his internship, residency training in internal medicine and specialty training in endocrinology at the premier UP-PGH on sulfonylureas. The amiable doctor who helped financed his studies making the best tasting ube and strawberry jams in Baguio traced the evolution of sulfonylureas from first to second to third generation, all of which have the same mechanism of action- that of stimulating the beta cells of the Islets of Langerhans of the pancreas to secrete and release insulin in response to elevated blood sugar. Then Dr. Solimen zeroed in to the sterling qualities of Glimiperide, a 3rd generation sulfonylurea, and enumerated its class effects but also its unique characteristics that set it apart from its predecessors.

Sulfonylurea receptors are found all over the body including the heart. Glimiperide has a selective attraction or avidity for the receptors in the pancreas leading to a more effective release of the much needed insulin to counteract the upsurge of sugar. On top of that, its binding to the receptor is more reversible than the older sulfonylureas, this translates clinically into lesser risk of the much-dreaded hypoglycemia- sudden significant drop in blood sugar which is a lot more serious than hyperglycemia. Of course sulfonylureas are known to increase weight but again, in the totem pole Glimiperide is in the lowest rung.

There are many Glimiperides in the market. With the indulgence of our readers and fellow doctors, there is Getryl which with its available dose strengths of l,2,3,4 mg and color-coded at that, affords a more individualized management in blood sugar control depending on how high is the fasting, postprandial-after meals sugar rise or for that matter the HbA1c values. Indeed, life is made of choices and so do our choices of drugs to give. After all, no two diabetics are exactly alike.
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