Because glutathione is a tripeptide (a protein), the digestive system often breaks it apart before it can ever reach the bloodstream
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15 Apparent treatment failures may occur because of re-infection, co-infection with Giardia duodenalis or Cryptosporidium felis , or the presence of another concurrent diarrhea-causing disorder
Two cases of malignant tumors with metastases apparently treated successfully with hypoglycemic coma
10% excreted unchanged by the kidney contraindicated: hepatic dysfunction renal insufficiency Glimepiride: (Amaryl) monotherapy -- once a day administration or in combination with insulin most potent -- lowest dose of the sulfonylureas long duration of action: half-life = 5 hours hepatic metabolism: complete to inactive products Secondary Failure and Tachyphylaxis to Sulfonylureas: Treatment failures occur Possibly due to pancreatic B cell refractoriness or to loss of dietary compliance Combination of sulfonylureas and insulin would appear justified only in the presence of severe insulin resistance Metformin: (Glucophage) glycolysis stimulation-- increased glucose removal from blood decreased hepatic gluconeogenesis decreased glucose absorption rate from the GI tract reduced plasma glucagon in patients with refractory obesity and insulin resistance Advantages: does not cause hypoglycemia does not increased weight May be used in combination with sulfonylureas when sulfonylurea monotherapy is not effective most common -- gastrointestinal (20% frequency) anorexia, nausea, vomiting, diarrhea dose-related usually occurs upon initiation of therapy -- often transient in effect Decreased vitamin B 12 absorption
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