Prolonged hypoglycemia due to sulfonylurea in an elderly woman

Overuse of antidiabetic medications is the most common cause of hypoglycemia in diabetic subjects. Here, we report a case of hypoglycemia associated with sulfonylurea administration. An 83-year-old female patient was admitted to the emergency department with complaints of loss of consciousness and fainting. The patient's blood glucose level was of 33 mg/dL, and she received emergency treatment with an intravenous 10% dextrose solution. In conclusion, sulfonylureas in combination with antidiabetic therapy increase the risk of hypoglycemic events in elderly patients with renal failure. Therefore, we suggest that physicians should closely monitor these patients for hypoglycemia and, preferably, use drugs that have less hypoglycemia side effects

Effect of metformin and glimepiride on liver and kidney functions in alloxan-induced diabetic rats

Metformin and glimepiride have been marked as potential hypoglycemic agents for the treatment of type 2 diabetes. The purpose of this study was to investigate the effect of daily oral administration of metformin [500 mg/kg] or glimepiride [0.5 mg/kg] alone or in combination for 28 days on some physiological parameters and histological alterations in liver and kidney of the diabetic rats. Diabetes was induced by a single intraperitoneal dose of alloxan [150 mg/kg] Data showed that metformin and glimepiride alone or in combination induced a significant decrease in serum glucose levels in the diabetic rats. Treating the diabetic rats with glimepiride increased the AST activity significantly. Meanwhile, administration of glimepiride or metformin had no significant effect on the activity of ALT. On the other hand, the combination of both drugs exhibited a significant reduction in the activities of AST and ALT as compared to that in the diabetic control rats. Glimepiride treatment revealed that total protein and globulin levels were increased, while metformin or the combined drug resulted in a significant decrease in albumin level which almost reached the normal value and an increase in the globulin than that of the diabetic rats. Creatinine level improved significantly in all the treated groups in comparison to that of the diabetic group and reached the normal values. On the other hand, no sign of improvement in the levels of urea was observed in the rats treated with metformin or the combined drug, while treatment with glimepiride decreased urea levels significantly. Histological examination of liver in the diabetic rats showed extensive necrosis of hepatocytes, cytoplasmic vacuolation, distended sinusoids with massive congestion. In addition, the kidney glomeruli increased in size and the renal tubules degenerated. The treatment with metformin or glimepiride ameliorated the hepatic injury, at the same time; the combined drug caused severe destruction in the liver cells. The treated rats also exhibited shrinking in the glomerular capillaries with widening of Bowman's space, mesangial matrix expansion, necrosis and vacuolation of renal tubules. In conclusion, the combination of biochemical and histological biomarkers provides useful and sensitive tools in the investigation of chronic effects induced by diabetes and anti-diabetic drugs

Determination of chlorimuron and metsulfuron residues in two soils of Argentina using a rapid seed-bioassay.

The presence of chlorimuron ethyl and metsulfuron methyl in two soils was determined by a modified petri dish bioassay. Pregerminated seeds of maize and sunflower were placed in petri dishes containing 85 to 100 g of treated soil. Radicle root lengths were measured after 24 h. Chlorimuron had no effect on maize on the Balcarce soil, however 0.007 microg g(-1) decreased sunflower root length. Chlorimuron decreased maize and sunflower root length regardless application dose on the San Cayetano soil. Metsulfuron decreased maize root length at 0.04 microg g(-1) and sunflower at 0.021 microg g(-1) on the Balcarce soil. On the San Cayetano soil metsulfuron at 0.001 microg g(-1) decreased maize and sunflower root length. The phytotoxicity of chlorimuron and metsulfuron changed according to soil type and dose. Maize and sunflower were 1.3-1.5 and 1.3-1.8 times respectively more sensitive to chlorimuron on the San Cayetano soil than on the Balcarce soil. In the case of metsulfuron, maize was similarly sensitive on both soils but sunflower was 1.7-2.0 times more sensitive on the San Cayetano soil than on the Balcarce soil. Phytotoxicity increased as organic matter (OM) content decreased and/or when the soil pH and concentration increased.

Diabetes Mellitus tipo 2 / Type 2 diabetes mellitus

Atualizaçäo no tratamento do diabetes mellitus tipo 2: dieta, exercícios, novas drogas, importancia da associaçäo de medicamentos para o controle adequado e prevençäo de complicaçöes crônicas.(au)

Glimepiride - A short term trial of the clinical efficacy

Diabetes is a common disorder and is reaching epidemic proportions especially in the third world. In the last few years new drugs have emerged targeting at better pharmacokinetic and low side effect profile. Among them have been various insulin sensitizers and newer sulfonylurias. Glimepiride with an impressive tract record offered more benefits and improved quality of life. The clinical efficacy in relation to the commonly used or traditional sulfonylurias was thus evaluated in this short term open trial involving 48 patients. The objective was to determine the clinical efficacy, tolerability, side effect profile and the equivalent dose of glimepiride compared to conventional sulphonylurias. The advantages of this new second generation sulfonyluria are discussed

Farmacologia das sulfoniluréias / Pharmacology of sulfonylureas

No presente estudo foi descrita e evidenciada a farmacologia das sulfoniluréias, no tratamento do diabetes mellitus do tipo II (insulino-independente). Apesar da sempre crescente utilizaçäo destas drogas na terapia do diabetes, principalmente pela sua praticidade e rapidez, näo se pode deixar de esquecer o balanço entre as dosagens, contra-indicaçöes e o aspecto geral, físico e mental do paciente. Além disso, so cuidados gerais, a orientaçä para uma dieta equilibrada, a prática de exercício e os cuidados com a higiene pessoal do indivíduo diabético sä necessários para que o tratamento alcance o sucesso esperado

Histological and histochemical study of gastric and duodenal mucosa in diabetic patients on long standing sulphonylurea therapy

Endoscopic, histological and histochemical studies were done on the gastric and duodenal mucosa of 30 diabetic patients [13 females and 17 males]. Their ages ranged between 25-62 years and the duration of diabetic state varied between 5-20 years. Fifteen of them were treated by insulin [insulin dependent diabetics] and the other fifteen were treated by sulphonylurea drugs [non-insulin dependent diabetics]. The clinical data obtained from the patients showed that 70 percent had dyspeptic symptoms while the other 30 percent were free. Upper endoscopy revealed normal gastric mucosa in 80 percent, incompetent cardia in 6.7 percent and chronic gastritis in 13.3 percent. Also endoscopy showed normal duodenal mucosa in 90 percent, chronic duodenitis in 6.7 percent and small erosions in 3.3 percent. Histological study showed chronic superficial gastritis in 40 percent, chronic atrophic gastritis in 50 percent and normal gastric mucosa in 10 percent. Also it showed chronic duodenitis in 93.3 percent and normal duodenal mucosa in 6.7 percent. Histochemical study detected increased alkaline and acid phosphatase activities as well as increased mucopolysaccharide content in the gastric mucosa of 90 percent while the remaining 10 percent showed normal activity of the enzymes. Also duodenal mucosa showed increased activity of both alkaline and acid phosphatases as well as increased mucopolysaccharide content in 93.3 percent while 6.7 percent showed normal activity. From the results of the present work, the following could be concluded: [1] Chronic superficial and atrophic gastritis as well as chronic duodenitis are common in diabetics. [2] The absence of dyspeptic symptoms in diabetics does not mean the absence of gastric and duodenal mucosal changes. [3] The endoscopic picture is not of decisive help, while the histological and histochemical studies are of great importance, in the diagnosis of gastric and duodenal mucosal changes in diabetic patients. [4] The line of treatment of diabetics, whether by insulin or by sulphonylureas, has no role in the development of gastric and duodenal mucosal changes as these changes occurred in both groups. [5] The long duration of diabetic state has no role in the development of mucosal changes as 10 percent were found free from such mucosal changes although they had diabetes mellitus for more than 5 years, even one of them was diabetic for more than 12 years

Hipoglicemiantes orais / Oral Hipoglycemic agentes

Os hipoglicemiantes orais säo representados pelas sulfoniluréias e as biguanidas. As sulfoniluréias agem estimulando as células beta das ilhotas de Langerhans para a secreçäo de insulina e as biguanidas diminuindo a absorçäo de glicose ao nível do trato gastrointestinal. Dentre as sulfoniluréias temos as de primeira geraçäo com açäo mais prolongada e as de segunda geraçäo, 10 a 20 vezes mais potentes, mas com meia vida plasmática mais curta. Todas, com exceçäo da gliquidona, säo eliminadas por via renal, e assim contraindicadas em pacientes urêmicos. O uso das biguanidas está proibido nos E. U. A. e Inglaterra, mas no Brasil ainda estäo sendo comercializadas, mas devem ser usadas com cautela, pois existe o risco de acidose lática em pacientes predispostos a estados de anóxia. Os hipoglicemiantes orais estäo indicados nos pacientes portadores de diabetes mellitus tipo II, insulino independentes, que ainda têm capacidade pancreática para secretar insulina