Current status of aryl sulfonylureas in treatment of diabetes mellitus

Tolbutamide, an aryl sulfonylurea closely related to carbutamide, was used in the treatment of 18 diabetic patients. Three were patients with diabetes of the severe labile type in whom insulin shock and ketosis were never far apart; six had moderately severe stable adult diabetes in which insulin had been required for adequate control; six had mild stable adult diabetes that could be adequately controlled by carbohydrate restriction without insulin; three had very mild adult diabetes. After a sevenday control period to establish base lines, the daily administration of tolbutamide was begun. The usual starting dose was 3 gm. by mouth as a 2% solution of tolbutamide in 0.5 % sodium bicarbinate solution. The patients with labile diabetes receiving insulin did not benefit from tolbutamide in large doses, and profound hypoglycemic shock was encountered in one. The best results were seen among the 12 patients who had stable diabetes requiring treatment of some sort; in 7 of these, the daily oral administration of tolbutamide in doses of 3 to 6 gm. per day diminished fasting hyperglycemia and suppressed glycosuria, but only one of the 7 had been in the group previously requiring insulin for adequate control of diabetes. Copyright, 1956, by American Medical Association