Medicine: Pills for Diabetes

The U.S.’s 1,000,000 diabetics have had high hopes for two drugs that, taken by mouth, might free them from daily injections of insulin (TIME, Feb. 27). Last week the reports were mixed.

¶Indianapolis’ Eli Lilly & Co., makers of carbutamide (originally known as BZ-55), warned doctors that among an estimated 1,000 patients who have received carbutamide in the last 18 months there have been eight deaths for which the drug may have been at least partly responsible. There was yet no proof that carbutamide was solely to blame but Lilly was putting doctors on guard. About 5% of patients had skin rashes, loss of appetite, nausea, drug fever, or lowering of the white blood-cell count. In nearly all such cases the symptoms went away when the drug was stopped.

¶Kalamazoo’s Upjohn Co., distributors of tolbutamide (trade-named Orinase), reported only mild skin rashes, indigestion or stomach distention in a small proportion of the 10,000 diabetics who have received this drug in the last year.

Neither drug is a substitute for insulin. Therefore, neither can be used for patients whose own insulin output is at or near the vanishing point-thus excluding everybody whose diabetes developed in early life. Also excluded are older patients who have severe ups and downs.

But carbutamide or tolbutamide tablets may help a vast number of diabetics: persons in middle or late life, usually those of a rather heavy or stocky build, whose disease is relatively mild and stable: 80% of such patients get prompt relief. If the drugs do not work, the patient can be put back on insulin immediately with little or no harm done. A rough-and-ready guide to indicate who may benefit from the new tablets if and when they become available for general prescription use: patients who normally need 40 units of insulin a day or less can get by with the drugs; those who need more insulin cannot.