Tolbutamide is a medication that is used to treat type 2 diabetes and belongs to the sulfonylureas group of drugs. Diabetes occurs when insulin in the blood is not used normally and so the blood sugar levels cannot be controlled and need tolbutamide to help lower blood sugar levels especially when a controlled diet to lower sugar levels fails.
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Tolbutamide accelerates the secretion of insulin in the pancreas, as without the production of insulin the drug is ineffective as it cannot then help the body to use insulin properly. Tolbutamide is never used in the treatment of type 1 diabetes as in that condition insulin is not produced and so sugar cannot be controlled through this drug.
Before you start with tolbutamide your doctor should know what prescribed and unprescribed remedies you are already taking, especially if you have been prescribed antibiotics and anticoagulants to thin the blood or if you are taking drugs for high blood pressure or heart disease and any MAO inhibitors. Some other medications that could also interfere or cause a side-effect with tolbutamide are oral contraceptives, prednisone, probenecid (Benemid), phenytoin (Dilantin) and even vitamins. The doctor should also be told if you are allergic to any drug including tolbutamide.
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The doctor should also be informed of any medical history of kidney or heart disease. In case you need to have any surgery, including dental surgery it should be told to the doctor before you begin to take tolbutamide. The surgeon and your dentist also need to know if you are already on tolbutamide.
In case you become pregnant while on this drug you need to inform the doctor right away. Before you start on tolbutamide your doctor should know if you are already pregnant or are breast feeding.
Another precaution while you are on tolbutamide is that you must protect yourself by wearing sunglasses, using sunscreen or wearing protective clothing if you need to be in the sun for a prolonged period of time. The best is to avoid unnecessary exposure to sunlight as tolbutamide can cause the skin to turn sensitive.
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Tolbutamide is recommended for patients with type 2 diabetes to control sugar that is not dependent on insulin being injected. Though a controlled diet is the first line of treatment, medication with tolbutamide becomes necessary when hyperglycemia cannot be brought under control.
Controlling diet cannot be emphasized enough for obese diabetic patients who need to restrict their caloric intake as weight needs to be kept in check as well as the blood sugar levels. Many times proper management of diet along with a regular physical activity is sufficient to control the high blood sugar levels or hyperglycemia. Diabetic patients are often at risk for cardiovascular stress. They should identify such risks and take corrective steps to prevent heart problems.
When diet fails to reduce blood sugar levels then patients need to consider the option of an insulin or sulfonylurea based oral pill. The patient, as well as the doctor both need to discuss the use of tolbutamide tablets along with dietary controls. The tablets should not be considered as a replacement for dietary restrictions or as a convenient option to avoid food restraints. Sometimes the use of tolbutamide becomes imperative especially when blood glucose control through diet tends to be temporary. Usually a short term dose of tolbutamide tablets can lower blood sugar levels.
Tolbutamide tablets can be discontinued when, after clinical and laboratory testing, it is observed that the medication is no longer helping to reduce blood sugar levels over a period of time. A regular check for blood sugar levels is often considered mandatory for diabetes patients.
The use of tolbutamide tablets by asymptomatic patients who are recognized as being non-insulin dependent is effective most times in controlling blood sugar levels. However this medication should not also be considered as being effective in the prevention of neural and long term cardiovascular complications which could result from diabetes.
The medication is taken orally and it is recommended that you should take it at the same time as regulated by the doctor. Usually it is one tablet during or after breakfast and in case your doctor thinks you require a higher dosage he would ask you to take it with or after any two meals in the day instead of one. Whatever the dose, it should be taken regularly so its benefits can be maximized.
The doctor will advise dosage according to your medical condition and the line of treatment. The doctor may first put you on a low dosage to see how you respond to the treatment. He might continue the same dosage or increase it and will adjust it judiciously depending on your blood sugar levels. Once the best dose is established he will then ask you to continue along that line so that blood sugar levels remain stabilized.
The doctor's instructions for the number of tablets to be taken and how often should be followed religiously otherwise there could be complications like upset stomach and low blood sugar levels. The highest possible dosage given is 2000 milligrams in a day. Also you need to follow the doctor's instructions for continuing or stopping any other anti-diabetic drug you might be taking like metformin or insulin before you begin with tolbutamide.
How tolbutamide works on lowering blood sugar levels in long term usage is not clear but it seems that it works as a stimulus that causes insulin to be released from the pancreas, a process which comes into effect when beta cells in the pancreatic islets begin functioning.
When diabetes reaches the chronic stage in type 2 diabetes, insulin secretion becomes less responsive to tolbutamide. However, the drug's effectiveness in lowering glucose levels in the blood is still maintained. Oral sulfonylurea medications, of which tolbutamide is a part, are used as hypoglycemia drugs as they set off pancreatic mechanisms effectively.
It has been observed that patients who earlier showed a good response to drugs like tolbutamide sometimes stop responding or show lower response over a period of time. This hypoglycemic drug proves effective in patients who have stopped responding to other sulfonylurea medications.
Tolbutamide works to stimulate the beta cells in the pancreas to produce insulin. Once insulin is produced in the requisite amount the insulin will in turn work simultaneously to remove sugar from the blood. Another area that tolbutamide functions in is that it assists in taking sugar from the blood into muscle and fat cells. It also helps to lower sugar production in the liver. These actions produced by tolbutamide help to lower blood sugar levels in patients with type 2 diabetes.
A restriction is usually placed on some kinds of food for diabetic patients. It is advisable to follow that diet as closely as possible to avoid complications from appearing.
Herbal medicines or minerals are also used by patients to reduce sugar levels. Chromium changes the way the body uses up sugar. DHEA may prove to be insulin resistant or may change the sensitivity to insulin. Other herbal substances and plants that affect sugar levels are ginger, garlic, ginseng, hawthorn, licorice, some nettles and yohimbe. However if you are already following these herbal remedies then tolbutamide will need to be adjusted according to the herbal dosage. It is always advisable not to combine herbal remedies with allopathic hypoglycemia medicines.
Alcohol is best avoided or should be taken in moderation as it can easily cause blood sugar levels to shoot up. Sometimes tolbutamide shows intolerance to alcohol and the person who has been administered the drug could show side effects like flushed face, palpitations accompanied by sweating. Tobacco smoking on the other hand could lower tolbutamide effectiveness as it decreases the amount of this drug in the blood.
Some illnesses that do not have a direct bearing to the administration of hypoglycemia medications but which do affect diabetic patients are acute infections, serious injuries or any surgery, any illness that causes vomiting and diarrhea. In any of these situations call the doctor immediately as there may be need to administer insulin to control diabetes.
Tolbutamide should not be discontinued without the doctor's recommendations. Also a six monthly review of the effectiveness of the drug must be ascertained as there could be secondary failure.
The medicine must be stored out of reach of children and in the same container it came in so there is no mix up. The lid should be tightly closed and it should be protected from heat and moisture. Storing it in the bathroom is not a good idea. Any medication that is past its expiry date should be disposed in a manner that has been advised by the pharmacist.