Sulfonylureas: What They Are, How They Work, and What Alternatives Exist

When you have sulfonylureas, a class of oral diabetes drugs that stimulate the pancreas to release more insulin. Also known as insulin secretagogues, they’ve been used for over 70 years to help people with type 2 diabetes manage their blood sugar. Unlike newer drugs that improve how your body uses insulin, sulfonylureas push your pancreas to produce more — which works well for many, but not everyone.

These drugs include common names like glyburide, a long-acting sulfonylurea often prescribed for stable, long-term blood sugar control, glipizide, a shorter-acting option that’s less likely to cause low blood sugar between meals, and glimepiride, a once-daily pill that’s become popular for its balanced effect. Each one works similarly but has different timing, strength, and side effect risks. They’re not for type 1 diabetes or people with severe pancreatic damage — if your body can’t make insulin at all, these pills won’t help.

One big downside? Low blood sugar. Because sulfonylureas force your pancreas to keep releasing insulin, even when you haven’t eaten, your blood sugar can drop too low — especially if you skip meals, exercise more than usual, or drink alcohol. Weight gain is another common issue, since extra insulin tells your body to store fat. That’s why many doctors now turn to newer options like metformin, SGLT2 inhibitors, or GLP-1 agonists first — they’re less likely to cause these problems and sometimes even help you lose weight.

But sulfonylureas aren’t gone. They’re still used because they’re cheap, effective, and well-studied. For older adults on a tight budget, or people who can’t afford newer meds, they remain a practical choice. And if you’ve been on them for years without issues, your doctor might keep you on them — as long as you watch for signs of low blood sugar and stick to your meal schedule.

The posts here cover how these drugs fit into real-life treatment plans. You’ll find comparisons with other diabetes medications, tips for avoiding side effects, and insights into why some people respond better than others. Whether you’re just starting treatment or have been on sulfonylureas for years, you’ll find practical advice on managing your health without guesswork.