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<blockquote data-quote="Dennis" data-source="post: 72559" data-attributes="member: 1338"><p>Hi Una,</p><p></p><p>I think your GP was perhaps trying to blind you with his great knowledge! Vildagliptin is not in any way a replacement for a sulphonylurea (e.g. gliclazide) because it works in a completely different way. I'll risk boring you with the explanation, but I won't be offended if you nod off before the end!!</p><p></p><p>Vildagliptin is a class of treatment called a DPP4-Inhibitor. When you eat your stomach produces enzymes which send messages to your pancreas to start producing insulin because food is on the way. Our bodies have an autoimmune system that is designed to kill off anything they think shouldn't be happening. Unfortunately in quite a lot of type-2s one of the autoimmune enzymes (Dipeptidyl peptidase-4, usually called DPP4), kills off the stomach enzymes before they can reach the pancreas. So your pancreas doesn't get the message and your blood sugar has already risen to a pretty high level before the pancreas starts to realise that it should have been doing something! What Vildagliptin does is to kill off the DPP4 enzymes before they are able to attack the stomach enzymes. That means your pancreas does get the messages and will produce the right amount of insulin to deal with what you are eating.</p><p></p><p>By contrast gliclazide simply tells your pancreas to produce insulin and to keep on doing that until the gliclazide wears off (whether that much is needed or not). That is why gliclazide can often trigger a hypo and your pancreas may end up producing too much or too little insulin because it will simply respond to what the gliclazide tells it to do. I would certainly say that the DPP4-Inhibitors are a far better treatment because they ensure that your pancreas produces the appropriate amount on insulin, rather than the uncontrolled insulin production that you get with the gliclazides.</p><p></p><p>Still awake?!?</p></blockquote><p></p>
[QUOTE="Dennis, post: 72559, member: 1338"] Hi Una, I think your GP was perhaps trying to blind you with his great knowledge! Vildagliptin is not in any way a replacement for a sulphonylurea (e.g. gliclazide) because it works in a completely different way. I'll risk boring you with the explanation, but I won't be offended if you nod off before the end!! Vildagliptin is a class of treatment called a DPP4-Inhibitor. When you eat your stomach produces enzymes which send messages to your pancreas to start producing insulin because food is on the way. Our bodies have an autoimmune system that is designed to kill off anything they think shouldn't be happening. Unfortunately in quite a lot of type-2s one of the autoimmune enzymes (Dipeptidyl peptidase-4, usually called DPP4), kills off the stomach enzymes before they can reach the pancreas. So your pancreas doesn't get the message and your blood sugar has already risen to a pretty high level before the pancreas starts to realise that it should have been doing something! What Vildagliptin does is to kill off the DPP4 enzymes before they are able to attack the stomach enzymes. That means your pancreas does get the messages and will produce the right amount of insulin to deal with what you are eating. By contrast gliclazide simply tells your pancreas to produce insulin and to keep on doing that until the gliclazide wears off (whether that much is needed or not). That is why gliclazide can often trigger a hypo and your pancreas may end up producing too much or too little insulin because it will simply respond to what the gliclazide tells it to do. I would certainly say that the DPP4-Inhibitors are a far better treatment because they ensure that your pancreas produces the appropriate amount on insulin, rather than the uncontrolled insulin production that you get with the gliclazides. Still awake?!? [/QUOTE]
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