Question

Hermione is using a combination of glyburide and pioglitazone for the treatment of type II diabetes. Her condition is stable as she remains relatively compliant with her treatment. At her bachelorette party, she drinks a more than what she is used to, and faints soon after thereafter. Before fainting she experienced an elevated heart rate and confusion. She is rushed to the hospital, where they administer IV glucose and dextrose. Regarding the presentation, i) explain the underlying reasons leading to her fainting, and ii) why she received glucose as emergency treatment.

Answer 1

Glyburide and pioglitazone are both hypoglyceamic agents.

i)Glyburide belongs to the class sulfonyl ureas and brings out the hypoglycemic effect by increasing the secretion of insulin from the beta cells of pancreas.And pioglitazone belongs to the thiazolidinedione where they act by elevating the sensitivity of insulin of the cells.And that is the reason why these drugs are administered as a combination.

The overall effect is the depression in the blood glucose levels.Now, alcohol when taken further accentuates or increases the hypoglycemis effect.This is because alcohol acts as an inhibitor to gluconeogenesis where glucose molecules are synthesised in the body.

Therefore, all three agents brings about hypoglycemia.When the blood glucose levels falls drastically as described in case of excess alcohol intake along with the drugs, energy deprivation happens due to decreased glucose in cells.This will stimulate the sympathetic nervous system and causes central effects such confusion , sweating and increases the heart rate by the same sympathetic stimulation.

ii)Since it is because the glucose levels have gone down,therefore the administration of glucose will replenish the deficit glucose and raise their level, and thereby increases glucose for energy production.