Sulfonylureas act by binding to a subunit of the ATP-potassium channel and causing it to close. The channel is not comepletely closed, and even with the drug bound can still somewhat open. This means that even when the system is completely saturated with the drug, there will not be complete inhibition. These channels that are blocked are also found in muscles in the body, which could be a problem with the inhibition except that these cells have a slightly different drug binding domain.
Other aspects that make this drug highly effective are that it increases insulin sensitivity and a decrease in hepatic glucose production. The insulinotropic response that is increased after meals is increased by this drug, but the exact path of this drug is still not clearly known.
The worst side effect of the drug is hypoglycemia cause
by overproduction of insulin. There are two levels of failure associated
with this treatment, primary is when the failure is initial and secondary
occurs after the drug appears to be working and then decreases in effectiveness.
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glimepiride