type-2 diabetes

For people with type 2 diabetes, meglitinides can help to lower blood glucose, especially after meals.

Meglitinides stimulate the pancreas to release insulin in response to eating a meal. Surges in blood glucose after eating often go undetected and have been shown to contribute to increased A1C levels. These medications reduce elevated blood glucose after a meal (postprandial hyperglycemia). Prescribed brands are Prandin (repaglinide) and Starlix (nateglinide).*

• Meglitinides are taken before each meal, usually about 15 minutes before eating. Doses usually are taken two to four times a day, depending on a person’s meal pattern and other factors.

• Like sulfonylureas and insulin, meglitinides (especially repaglinide) increase the risk of hypoglycemia. People who use meglitinides need to watch for symptoms of hypoglycemia and take steps to prevent this complication or treat it promptly at the first sign of low blood glucose.

* Note: Although repaglinide and nateglinide are both meglitinide analogues with similar mechanisms of action, these two agents differ chemically. Repaglinide is a benzoic acid derivative and nateglinide is a D-phenylalanine derivative.

Insulin sensitizers reduce insulin resistance, a major cause of type 2 diabetes.

The insulin sensitizers (also called thiazolidinediones or TZDs) reduce insulin resistance. By facilitating insulin action and allowing glucose to enter cells more easily, these drugs help lower blood glucose levels. Prescribed brands are Avandia (rosiglitazone) and Actos (pioglitazone).

• Very rarely, insulin sensitizers can cause serious damage to the liver. People who take insulin sensitizers need regular blood tests to monitor the health of their liver. Blood tests to check liver function should be performed before the medication is started, every 2 months for the first year, and periodically thereafter. In addition, people should tell their doctors if they have liver disease or if they experience signs of liver problems while taking an insulin sensitizer, such as unexplained tiredness, dark urine, or yellowing of the skin.

• Some people may experience tiredness, weight gain, or swelling of hands and feet while taking insulin sensitizers. A person who experiences an unusually rapid increase in weight, swelling, or shortness of breath while taking an insulin sensitizer should contact the health care team immediately.

• TZDs have been associated with increased fluid retention and increased risk of congestive heart failure in those already at high risk. Care must be taken to select users cautiously and screen at appropriate intervals.