Many people are familiar with this class of drugs. Some individuals with diabetes have taken them for years. Initially, blood sugar levels were well-controlled, but after a few years, control became increasingly difficult. Increasing the dosage would help for a few more years, followed by another loss of control. The dose kept doubling, blood sugar became harder and harder to manage, and eventually, insulin was required. This is the typical progression for most diabetic patients using sulfonylureas.

What drugs are included in the sulfonylurea class?

These include glimepiride, gliclazide, gliquidone, glipizide, and Xiaoke Pills. Many patients mistakenly believe Xiaoke Pills are a traditional Chinese medicine, but in fact, every 10 pills contain 2.5 mg of glyburide.

Why are these drugs unsuitable for patients with type 1 diabetes or type 2 diabetes with very poor pancreatic islet function?

The mechanism of action of these drugs is to stimulate pancreatic beta cells to secrete insulin. For patients with type 1 diabetes or severely compromised islet function, where the islet function is already very poor or nearly lost, these drugs can stimulate very little additional insulin secretion. Blood sugar will not be effectively lowered, and the risk of liver and kidney damage is increased.

Why do patients on long-term sulfonylurea therapy experience the aforementioned pattern of worsening blood sugar control and ever-increasing doses? Initially, when islet cells are merely in a state of overwork, correct intervention focused on improving islet function is not implemented. Instead, the focus is solely on lowering blood glucose numbers, using these drugs to constantly stimulate the already overworked islet cells. This pushes the overworked cells gradually into apoptosis. At first, when the number of overworked cells exceeds the number of apoptotic cells, blood sugar control may still be acceptable. Over time, as apoptotic cells outnumber overworked cells, the same drug dose becomes ineffective for blood sugar control. The dose is then increased, perpetuating a vicious cycle. The final result is the promotion of death in a large number of islet cells, leading to uncontrolled blood sugar. Even insulin therapy may then be less effective, complications emerge, and this process can develop rapidly.

Therefore, out-of-hospital management focuses on systematic adjustments aimed at improving the patient's islet function, not merely on reducing blood glucose numbers. Diet, exercise, medication, emotional state, sleep, and nutrition are all indispensable. There is no blood sugar that cannot be controlled; the issue lies in the treatment approach. Among all patients under my out-of-hospital management, not a single one has abnormal blood sugar levels—all achieve their targets. Some might say they don't believe it, asking if hospital specialists aren't more knowledgeable. Honestly, in terms of theory and research, Dr. Wu may not surpass the experts. However, if you are under Dr. Wu's out-of-hospital management, I can provide 24/7 follow-up guidance, addressing any blood sugar-related issues you raise anytime, anywhere. Can the specialist treating you do that? I suspect not—without an appointment, you can't even see the specialist.

A patient once joked that Dr. Wu's phone is the most valuable thing. It's not about the phone's monetary value, but because it contains all the information from patients under out-of-hospital management over the past decade. For each person, the records detail the initial condition and the entire management process, providing a complete data history. It truly is a great treasure.