 Hey guys, this is Dr. Ahmet Ergin. Welcome to Sugar MDs. Today we are going to talk about Sophenolureas, Glyphazide, Glymobriac, Libriac, the most commonly prescribed medications. And we are going to touch base starlets and brand it. We are going to talk about the differences between Sophenolurea class, GLP1 class, and insulin sensitizers. So tune in. And if you like this video, do not forget to give it thumbs up and subscribe. And welcome to Sugar MDs. Today I am going to talk to you about some of the medications that you guys have been prescribed quite often. And the topic is the Sophenolureas. So Sophenolureas most commonly are Glyphazide, Glymobriac, and Glyboride. And Melitonide is almost like a subgroup of Sophenolureas. And these are like starlets, which is Nephegalonide, and Prondin, which is Rephegalonide. Now, why we are talking about Sophenolureas today, because they are very inexpensive. They are widely available. They are the most commonly prescribed medications. So the most commonly prescribed medications that does not necessarily mean they are the best medications. So we are going to talk about what they do, why they are not the best medications, and what are the alternative medications out there that you can consider. Now, of course, the best medication is no medication. So if you can manage your diabetes at the early stages, hopefully with no medication without an exercise, that will be the best scenario. But should you need a medication, I want you to be on a medication that you will get the most benefit and the least side effects. Now, the theory behind the Sophenolureas, the way they work, is that they actually make your body produce insulin. So they basically go to your pancreas. And in pancreas, there are cells called beta cells. The beta cells are stimulated by Sophenolureas. Now, this first group we call them Sophenolureas are longer-acting, and Melitonides are shorter-acting, which are starlings and prondin. Now, the problem with Sophenolureas is you have to take it early in the morning before the breakfast. And if you don't have a breakfast, that's a problem because immediately after you take Glyphazide, for example, your insulin will go from here to here. Now, you can't see the problem, right? This is not much different than just taking an insulin shot. Now, people think that when they take pills that is mild, or that's okay, or that's not a big deal, you can get away with things, but that's not true, especially with Sophenolureas. If you take that pill, you have to eat. Now, the problem is we tell diabetics not to eat, but then we give a pill and tell them to eat. And if we tell them actually eat well, because if you don't eat well, your blood sugar may go down. Now, that is a problem, right? Don't you think so? I mean, now, of course, what happens when you tell people go eat? Of course, they are going to gain weight, and we tell people to lose weight and we give medications that they are going to end up gaining weight. Now, also, we tell people not to have low blood sugars, but this is the best remedy to have a low blood sugar, because as I said, your insulin level will go up right away, and if it didn't have any food, then that is a problem. Now, what are the problems we are experiencing here? If you have a kidney problem, all these medications are excreted by kidneys. Okay, so people are scared of metformin, thinking that the metformin causes kidney damage. There is no data whatsoever in this earth that says metformin causes kidney damage. There is data that says the metformin can accumulate when somebody has chronic kidney disease that is advanced enough, and then there is a slight risk of metabolic acidity and so forth, so we stop the metformin. But the problem is people are misinformed, and they don't really hear from real doctors, they end up hearing from sources like internet and so forth, and they end up believing that the metformin is causing the kidney failure, which is not true. But in this case, actually, similar to metformin, these medications can accumulate, and even in the early stages of kidney failure, the glopazide, gloparide, and gliboride can accumulate in your system. So what does it mean? If you are taking these medications, and if they're accumulating in your system, if you end up having a low blood sugar, it's going to be very hard to get out of that blood sugar. It's like someone is infusing insulin through your IV lines. Because these are staying in your system, they are not cleared because of your kidney dysfunction, and you are going to end up having insulin production constantly. So I have seen many cases of patients in the hospital under IV glucose infusion for like two, three days because they were taking these sulfonylureus. Now, you may have been prescribed sulfonylureus just recently, or you have been using sulfonylureus for a long time. A lot of people can still use sulfonylureus just fine, but it does not mean that they are the best medications, right? So another big theory about the sulfonylureus, and the reason they are out of favor right now, is that it's believed the sulfonylureus can actually kill your pancreas. So that is, a theory, it is not 100% proven, but when they did studies comparing sulfonylureus with, for example, insulin sensitizers metformin or piagolotazone. When they compared sulfonylureus to these insulin sensitizers, patients who were taking sulfonylureus ended up needing insulin way faster. So that means that if you're on sulfonylureus, you may end up with insulin faster. Now, again, you may have been on sulfonylureus for 20 years and you may say, hey, you know, I don't need insulin still, but I'm not talking about specific cases. You're talking about studies, you're talking about, you know, general population. Again, everybody is different, but generally, let's say to make it simple. If you put 100 people on sulfonylureus, okay, so 10 people may just do fine and they may never need insulin. Okay, so 50 people will probably need insulin within five, 10 years. And maybe another 40 people will end up needing insulin within a few years. So that is what I'm talking about. So your case may be different, but the studies indicate that these agents can end up actually straining your beta cells. Now, why is that? So think about this. If you're already tired, right, you personally, you're tired and your boss comes with a whip and says, work, work, work, you're gonna lose your job if you don't work more and so forth. So sulfonylureus are just like a whip on your pancreas. So you're whipping somebody who's already tired, you're whipping them to work harder. What's gonna happen? They're gonna end up falling dead, right? So that's what happens to your beta cells, guys. So when you constantly make your beta cells work, because these guys are going and sitting like literally sitting on your beta cells and asking them to constantly work as a result, your insulin levels constantly are high. You're constantly hungry. And the moment you skip a meal, bam, your blood sugars are down and you're in trouble. So why sometimes be used megalithonides because they're shorter acting, but they pretty much are the same thing. Instead of whipping your pancreas 24-7, they're whipping your pancreas for, you know, seven to eight hours. They are still problematic. They are kind of still expensive, to be honest with you. I know why they are generic and expensive. That doesn't make any sense. But they still cause weight gain. They can still cause low blood sugars. It's just shorter acting. So they're gonna give you a shorter trouble time than a longer trouble time. Now, what are our alternatives? So if you're on sample urea, and if you want to move on to another agent, what would you choose? Now, as doctors, we use metformin, of course, in appropriate patients. Not everybody is a candidate for it. Pyagyltazone is another agent, which is not super popular nowadays. But I think it's still a good agent to use. There are some there are some caveats to Pyagyltazone when you choose the right patient, which I'm not gonna go into super detail about every drug because the topic today is cell phone ureas. And acarbose, which is pericose, is another agent that can be used. Now, acarbose is not an insulin sensitizer. It's an alpha-glucozidase inhibitor. And what it does, it basically does not let you absorb glucose, or it lets you, but it's gonna be it's gonna have a much slower rate. So that allows the insulin production, the needs much less. Now, of course, another class, GLP1 class in the last 10 years, they came to the market. Now, there's a lot of good things about GLP1s. There's really the study so far does not say anything too negative about GLP1 class because they do everything that we want a medication do. What do we want from a medication? We want the medication to stimulate your beta cells only when needed. So you don't want to tell your beta cells to constantly work. They just need to work. When you eat, when you need insulin bolus, then this agents do that. They also slow down your absorption so your glucose is not going to rush to your intestinal system and to your blood, which will require insulin secretion. And if you don't have that enough, then you're gonna have a blood sugar spike. The GLP1 class, in this class again, we have ozambic, ribalsis, mucosa, bi-reinbiata, turlis, etc. But this class will slow down your absorption, which is another good thing. Now, what is the third good thing about the GLP1 class is it is going to suppress your appetite. Now, did you pay attention to something? GLP1 class does exactly the opposite of southern Urias does. Now, they both reduce the blood sugar, but in a much different way. So some of these agents are actually most of these agents in GLP1 class are basically injections. Now, there has been some resistance on the patient side, especially in primary care world, because patients don't want to take injections. Injections is just a taboo. People associate injections with insulin. Although, you know, we try to explain that these are not insulin at all. They just make your body produce its own insulin, etc. But they still have a trouble understanding. That's why I'm here, because I don't think your doctor will take that much time to explain all those things to you so you can make the right choice. And as a patient, I don't want you to go search on the internet and go to helpline.com or webmd.com and try to make your own decision. Not a good idea. So again, back to GLP1s. Remember, the southern Urias constantly secrete your insulin GLP1s only when you need the insulin. Southern Urias make you hungry. GLP1 class makes you feel full. Your appetite goes down. Southern Urias makes you gain weight. GLP1 class make you lose weight. Now, there are some really neat mechanisms behind GLP1 class. So what are they? Now, number one, yes, but the cells are stipulated only when needed. But also, there is alpha cells in your in your pancreas. And alpha cells are the glucagon screening. The cells that glucagon is exact opposite of insulin. So why do we need glucagon? Because if your blood sugar is plummeting, glucagon is the mechanism that comes into play to save you from a severe low blood sugar. And the problem is in patients with diabetes, there is a dysregulation. Glucagon is paradoxically squeated when your blood sugars are high. Remember, glucagon is only squeated or is supposed to be squeated when your blood sugars are low. But in bedics, because of the loss of feedback between insulin and glucagon, your glucagon will go up when you eat. Now, that is a huge problem. Although people don't talk about it, but there's a huge problem. Now, as a result, your blood sugars are going to have hard time coming down, even if you make insulin. Now, if your doctor tests your insulin or CPAP diet and so forth, they are going to come back just fine. Yeah, and you're going to be like, okay, well, if I'm making insulin, why is it not coming out? Yeah, they're gonna say you're insulin resistant. But yeah, that's a simple answer. But there are actually more to that. There are a lot of other hormones are involved. Glucagon is one of the main ones. Now, glp1 class will reduce that glucagon. So as a result, you're not going to have this paradoxical blood sugar spike after you eat. Okay, so most importantly, let me discuss with some philinearius guys. South Philinearius are basically squeezing the truth of your beta cells or ripping your beta cells to death. glp1 class on the other hand, actually studies show that when you use glp1 class, your beta cells will increase even in number, actually prolong your beta cells, it's going to prolong your time to go to insulin. And that's very, very important because what we don't want to do is to put our patients on insulin. So another very interesting study that I want to point out, which was a study that was done by semi-glutide molecule for ozampic and rebaltus, they're the same molecule ozampic injection rebaltus is a pill form. But what was interesting, I'm going to show you here in this graph. So when they looked at the placebo group, which is diabetic patients who did not get the semi-glutide, their insulin response in time was just like this. Now, I'm going to show you the normal group, the normal, the normal people who do not have diabetes, their insulin response was just like this to a, you know, food intake. So what happened after, I think 12 weeks of semi-glutide diabetic patients, again, this red line is the normal people is this green line here is diabetic patients who do not take semi-glutide. And what happened was patients who started taking diabetic patients who started taking semi-glutide, their insulin response became almost identical, almost identical to patients who do not have diabetes. Now, if you're talking about diabetes cure or diabetes remission, you can actually call that a diabetes remission or cure. And I have a lot of patients coming down to even say 5% with the GLP1 class. Again, these are the only downside of the GLP1 class, unfortunately, they're expensive. But there are copays, coupons, etc. that your doctors, your pharmacists can help you to get very, very good deals. Insulin sensitizers, again, metformin is free at Publix, piagolta zone is very inexpensive medication as well. Acarbose also is very inexpensive. The only problem with acarbose, it's a lot of gastrointestinal problems, especially flatulence gassing is a huge problem. Metformin also has a lot of gastrointestinal problems, which we will talk in another video. And the piagolta zone is a good agent doesn't have an immediate side effects. But sometimes, especially in elderly female patients, it can increase the risk of fractures if it is used for a prolonged amount of time. But other than that, octose is fairly good agent. There is there was some suggestion of a bladder cancer with octose. But that was a very few in number. So if you want to use a medication that is really not necessarily very expensive, but can help your insulin sensitivity, octose may be a good option. Either get confused on that. Again, cell phone, urea group, we sometimes use it if you are totally desperate, if the patient cannot afford anything else, if or sometimes they come to me and they say that I've been using this forever, and I'm fine. I'm not going to rock the boat, right? So I still mention other agents, the benefits of other agents, but if you're happy with your medication, and you have been fine, then fine, because we treat patients, we don't treat patients like numbers. Everybody's response is different. Everybody is a different individual. But I want you to be aware of the problems associated with cell phone ureas. Yes, they bring your blood sugar down, but they have a lot of other problems that go with it. Now I hope this video was helpful, guys. So if it was, please give it a thumbs up, and please subscribe to our channel. And we'll see you in the next video.