Glimepiride is a sulfonylurea antidiabetic medication drug, also known as a “secretagogue,” that stimulates the beta cells in the pancreas to produce more insulin. Insulin escorts glucose into the cells, preventing the build-up of sugar in the blood. It also increases the activity of insulin receptors inside the cells, thereby increasing insulin sensitivity. Even with all its protective effects, diabetics on this medication may suffer from glimepiride side effects long term and short term.
How Glimepiride Works in the Body
Glimepiride stimulates the beta cells of the pancreas to secrete insulin. It does so by specifically binding to sulfonylurea receptors of the pancreatic beta cells. This binding initiates a complex chain of events that finally leads to the secretion of insulin by the beta cells.
Another, beta cell-independent mechanism of the blood sugar lowering activity of sulfonylureas has also been theorized and studied. It was found that glimepiride increased glucose transport and lipid and glycogen synthesis in adipocytes (fat cells) and muscle cells. This means that glimepiride helps transport glucose efficiently and also helps in its conversion to glycogen to be stored in the liver.
Most Prescribed Names in This Category
Diabenese, Amaryl, Glynase, Diabeta, Tolinase Glycinorm, Glurib, Euroglip, Digraph and Glicept.
How Should This Medicine Be Used
Glimepiride is usually taken once a day, either along with breakfast or with the first major meal of the day. Always follow your doctor’s instructions and never take more or less of what has been prescribed to you.
Side Effects That Could Happen As Soon As You Start Taking the Medication
The most common side effects of Glipizide/Glimepiride/Glyburide (Sulfonylureas) are:
- hypoglycemia (low blood sugar and its related symptoms)
- weight gain, and
- allergic reactions, if you are allergic to Sulfa category of drugs
The pancreas releases the hormone insulin. Insulin delivers sugar from food into the cells for energy creation. Glipizide/Glimepiride/Glyburide (Sulfonylureas) stimulates the pancreas to release insulin. At times, the pancreas releases more insulin than needed. The increased insulin tends to act as a more powerful courier to “muscle” glucose into the cells, achieving lower blood sugar levels. This phenomenon could lead to the blood sugar dropping suddenly.
Low Blood Sugar
This could lead to:
- Excess sweating and feeling very hungry
- Feeling light-headed or shaky
- Nausea (affects a few people)
- Mental confusion
- Unresponsiveness (affects a few people)
- Dryness or tingling of lips (This could also be caused by hypoglycemia, induced by sulfonylureas.)
The cells grow fatter when excess sugar is “muscled” into them. The increased sugar load also leads to weight gain and there have been cases where the patient has gained as much as 2 pounds in a single week! Obese patients aren’t often prescribed sulfonylureas.
Sulfonylureas fall under the category of “Sulfa” drugs. Many patients have reported allergies to Sulfa drugs. The sensitivity to these drugs could cause skin rashes, hives, itching and swelling. So it’s really important to tell your doctor about allergies you know you have.
Some people also report digestive discomfort and headaches when they use Sulfonylureas. Importantly, blood sugar levels must be constantly monitored to critically adjust glimepiride dosage.
What Can You Do To Reduce Glimepiride Side Effects?
Work with your doctor to switch over to another class of medications or adjust the doses to levels that you can tolerate.
Should You Be Taking Glimepiride for a Long-Term?
A study has found a correlation between long-term use of sulfonylureas and death due to cardiovascular problems. This study prompted the US FDA to warn patients about possible risks of using these drugs in the long term.
Long term use of antidiabetic drugs in general and glimepiride in particular causes a number of health complications. The major reason for this is the nutrient depletion caused by these drugs. It is this nutrient depletion that is at the root of most of the health issues caused in the long term by these medications. The most important nutrient that is depleted by long term use of sulfonylureas is CoQ10. We’ve seen the importance of this little co-enzyme in things as diverse as energy metabolism to keeping our immune system healthy. Imagine how many things would go wrong inside the body that is being constantly deprived of this vital nutrient.
Glimepiride mechanism of action can lead to any of the symptoms below:
The heart is the most energy-intensive muscle in the human body. Energy is produced by muscles by using CoQ10. If you lose CoQ10 over a prolonged period of time, you could face:
- high blood pressure
- angina or heart pain
- irregular heartbeats or arrhythmias
- mitral valve prolapses
- congestive heart failure
- low energy
Slowly but surely, modern medicine is finding out that dental health, including that of gums, has a deep bearing on heart health. Gingivitis or gum infections and pain are known symptoms of losing CoQ10
CoQ10 is a critical component of energy production in the body. Low levels of it in the body are associated with repeated infections, lowered general immunity, etc.
What Can You Do About It?
The body gets depleted of vital nutrients after prolonged use of a drug. Replacing these vital nutrients can help curb these symptoms. If you’re on prescription medication, it’s always good to involve your doctor before taking dietary supplements. You can take a CoQ10 supplement that will provide you with around 30-200 mcg (upper limit often cited is 400 mcg per day) of the nutrient.
Doses are per day (unless stated otherwise), based on what seems to work in studies. Please consult your medical doctor for what supplement and dose may suit you best.
Special Precautions to be Followed While Taking Glimepiride
It should always be kept in mind that medications of this class can cause hypoglycemia (low blood sugar). If you are taking sulfonylureas, you should be able to recognize the signs and symptoms of hypoglycemia and should be able to correct the condition at your own.
Patients with a Glucose 6 Phosphate Dehydrogenase (G6PD) deficiency are at risk of hemolytic anemia (deficiency of RBCs due to their destruction) with sulfonylureas.
Sulfonylureas must be taken with great precaution and only if the benefits outweigh the potential risks in pregnant and nursing females.
Sulfonylureas should not be used for pediatric patients with type 2 diabetes.
What Should I Do If I Forget a Dose?
If you miss a dose, take it as soon as you remember it. However, if it is already time for the next dose, do not take a double dose. Take the regular dose instead. If you notice any adverse symptoms, contact your doctor immediately.
Storage and Disposal of the Medication
Store all your medications in a cool, dry place, away from direct sunlight and heat. Place all your medications such that children cannot access them. Do not store your medications in the bathroom as the hot, humid environment may reduce the efficacy of the drug. Keep your medicines preferably on your dining table so that you remember taking them on time. Always use medicines within the expiration date. All unused and expired medicines should be disposed of with care and by following the guidelines. You can also give your medicines for disposal to your local pharmacist.
Dietary Considerations while Taking Glimepiride
Glimepiride should be taken along with a diet and exercise regimen to control blood sugar. You need to restrict your carbohydrate intake while taking antidiabetic medication like glimepiride.
Alcohol consumption can affect action of glimepiride. Alcohol itself has a blood-sugar lowering activity. If it is taken while on antidiabetic medication, you run the risk of hypoglycemia.
Glimepiride interacts with 892 drugs, of which the most prominent interaction is with the antibiotic gatifloxacin. Gatifloxacin should never be used if you are on glimepiride therapy as the combination can lower blood sugar levels to disastrous levels.
Glimepiride has a moderate interaction with cetirizine and other medicines for symptomatic relief of colds, ibuprofen, certain steroids, aspirin, acetaminophen and certain antibiotics, among others. Check out this resource for the entire list.
Always talk to your doctor about any drugs you might be taking or planning to take while on glimepiride treatment.
Ingredients in the Medicine
Amaryl, the most popular drug of this class, contains glimepiride as the active compound. It also contains
- lactose (hydrous)
- sodium starch glycolate
- microcrystalline cellulose and
- magnesium stearate
Glimepiride, like all conventional antidiabetic medication, does a decent job of managing blood sugar levels in type 2 diabetics. It should, however, be taken as a part of a comprehensive strategy for controlling diabetes, along with diet and lifestyle modifications.
Like all other antibdiabetic medications, glimepiride is also guilty of causing side effects, both short term and long term. The fact that it robs vital nutrients like CoQ10 from the body is a matter of grave concern.
Research is showing us that a more holistic approach that includes diet, exercise and stress management techniques can help reverse type 2 diabetes. Reversing a chronic disease, like type 2 diabetes, is all about correcting the imbalance in the body. With the right diet and lifestyle modifications, it is possible to bring back the lost balance and reverse the chronic disease.