H is for Hypo

Hypos are in the news, thanks to prosecutors in Redwood City, California. They arrested Doug Burns for assault and resisting arrest last month after police sprayed him with Mace and wrestled to the ground outside of a movie theater where they thought he was drunk.

Turns out it was only a hypo. But a pretty bad one in a couple of ways. Besides getting himself arrested, his blood glucose level was way down to 26, when police took him to the emergency room.

A hypo is our familiar name for a hypoglycemic episode or low blood glucose. It’s familiar, but certainly not friendly.

Yesterday Chief Deputy District Attorney Steve Wagstaffe dropped the charges against Burns, who had a solid defense – being unconscious, Wagnstaff admitted. “He was not aware of what he was doing at the time of the conduct.”

Burns is 43 and holds the “Mr. Natural Universe” crown, meaning that he doesn’t use steroids. He is not “the Mr. Universe,” as most reports identified him. Even the current issue of Diabetes Health magazine calls him “Mr. Universe” on its cover. Eleven men can claim to be a “Mr. Universe,” including those in professional, amateur, and natural divisions. Burns does have type 1 diabetes.

Burns uses insulin, which everyone who also uses it knows can cause hypos. And about one-third of people with type 2 diabetes also use it. But do you know the other drugs that can have the same effect?

The other one that is far more likely to lead to hypos than any other diabetes medication is the class of drugs known as the sulfonylureas. Until metformin became available a dozen years ago, these were the only pills that people with diabetes could take to help control their diabetes.

People with diabetes still use several types of sulfonylureas. The first-generation sulfonylureas include Dymelor (acetohexamide), Diabinese (chlorpropamide), Orinase (tolbutamide), Tolinase (tolazamide). We don’t use them much any more.

But the second-generation sulfonylureas still get a lot of use. They include Glucotrol and Glucotrol XL (glipizide) and Diaßeta, Micronase Glynase PresTab (glyburide). The newest sulfonylurea is Amaryl (glimepiride). Generic sulfonylureas are also available.

Most everyone who uses them knows that these are sulfonylureas. But I wonder how many people recognize that three combination drugs also contain sulfonylurea and thus have the potential of causing hypos?

These combos are Avandaryl (Avandia and glimepiride), Glucovance (glyburide and metformin), and Metaglip (glipizide and metformin). All people with diabetes who take insulin or any of these sulfonylureas needs to be aware of their hypo-potential if they want to avoid being arrested like Mr. Natural Universe.

This article is based on an earlier version of my article published by HealthCentral.