Tag Archives: Hypoglycemia

A New Class of Diabetes Medication Arrives in Singapore

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Despite current treatment including insulin, only 40% of patients in Indonesia35% of patients in Singapore and 22% of patients in Malaysia have good diabetes control.

A new class of medication called the SGLT2 inhibitor has been approved in Singapore, the first one being Invokana (canagliflozin). It has a unique mode of action for the treatment of type 2 diabetes mellitus.

In the kidneys when blood is pushed through a glomerulus (the smallest operating unit in the kidney), glomerular filtrate (earliest urine) is formed. It contains glucose (sugar), different ions, water and waste products. The good stuff is retained through reabsorption. Glucose is reabsorbed through the SGLT2 channels.

SGLT2 inhibitors block the action of the SGLT2 channels, so glucose is lost in urine. Thus the blood glucose drops and diabetes control improves. Patients also lose weight as they are losing energy in the urine. The glucose in the urine also drags water with it and thus patients’ blood pressure drops.

The most important benefit is that it is not dependent on insulin secretion, so the risk of a dangerously low blood sugar (hypoglycemia) is prevented. With this extra class of oral medication, patients may be able to delay their use of insulin.

There are side effects though. First, the sugar in the urine increases the risk of a urine tract infection and fungal infection around the urethra. Second, patients can get dehydrated unless they replenish their fluids with an extra glass of water.

I am very glad that we now have another weapon in the treatment of diabetes.

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Avoid Glibenclamide for patients who are elderly or have renal failure

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Photo credit:  Gualberto107/freedigitalphotos.net

Glibenclamdie (glyburide in America) is a common and useful drug for type 2 diabetes. It is effective and the blood sugar lowering effect long-lasting. However, the strength is also a weakness: it can sometimes be so powerful that the patient can suffer prolonged hypoglycemia (low blood sugar level).

The Health Sciences Authority of Singapore had looked at the data and found that in Singapore, patients who are above 60 or those with kidney failure have a much increased risk of severe and protracted hypoglycemia. They have now advised all doctors to avoid using glibenclamide in those patients.

There are many other alternative drugs in the same class such as gliclazide and they are also generics, available at a low price at our clinics.

If you are taking glibenclamide and had recently turned 60 or have renal failure, please do not stop your medicine immediately, but talk to your doctor about it.

The Artificial Pancreas – Hope for Type 1 Diabetes

The artificial pancreas has just been approved by the American Food and Drug Administration (FDA).

Patients with type 1 diabetes cannot make insulin because their pancreas has been damaged by their own immune system, and have to have external insulin supplied to them. An insulin pump can provide insulin constantly through a needle that is secured just under the skin and typically lasts for 3 days. The problem had always been that patients can get hypoglycemia, or low blood sugar, especially during the night or during vigorous exercise.

Now the FDA had approved a new Medtronic pump that also has a sensor which can switch off the pump when the patient’s sugar drops too low. This pump now behaves like our real pancreas: provide insulin when the sugar is high, stopping insulin when sugar is low. However, it is not fully automated: unlike our body which knows how much carbohydrates we have taken, the pump user still needs to enter the amount manually into the machine.

Nonetheless this is a much safer machine than the old ones. Hopefully it will be brought to Singapore soon!