What to Know About Meglitinides

Meglitinides are oral medications used to treat type 2 diabetes. They work by triggering the production of insulin. Medications in this class include Prandin (repaglinide) and Starlix (nateglinide). The brand names Prandin and Starlix have been discontinued, but the generic medications are still available.

This article will provide information about what meglitinides are, what they're used for, and how they work for type 2 diabetes.

Uses of Meglitinides and How They Work

Meglitinides have been approved by the U.S. Food and Drug Administration for type 2 diabetes since 1997. The first drug in this class, repaglinide, was approved in 1997, and a second, nateglinide, was approved in 2000.

In the human body, insulin is produced by specialized cells in the pancreas called beta cells. In people with type 2 diabetes, the pancreas either doesn't produce enough insulin or the body doesn't use insulin efficiently. In both scenarios, blood glucose (sugar) levels are hard to control.

Meglitinides stimulate beta cells to produce more insulin, allowing the body to better process glucose, thereby lowering blood sugar levels. This particular class of medication is meant to help lower blood sugars after meals and is particularly helpful for those with flexible schedules and when consistent mealtimes aren't always possible.

Meglitinides can be used alone or in combination with other medications.

Before Taking Meglitinides

Meglitinides do not directly reduce blood sugar and therefore are not a substitute for insulin. They should be taken in conjunction with making lifestyle changes, such as following a healthy diet and increasing physical activity.

Precautions and Contraindications

Studies indicate repaglinide is comparable to other oral diabetes medications in lowering blood sugar. Nateglinide, while useful, may be somewhat less effective at lowering blood sugar levels than other anti-diabetes medications.

People with type 1 (insulin-dependent) diabetes or allergies to meglitinides should not use them. Those currently experiencing physical stress caused by infection, injury, or surgery may need to temporarily stop taking meglitinides. People with kidney disease should also consider other medication options since meglitinides can increase the risk of hypoglycemia in those with this condition.

Dosage

Meglitinides typically are prescribed to be taken about 15 to 30 minutes before each meal. If you miss a meal, you should not take the drug. If you tend to skip meals regularly, these medications probably are not right for you.

Side Effects

Meglitinides are well-tolerated by most people, including elderly people who need help lowering their mealtime blood sugars.

Common

Side effects of meglitinides include:

• Headache
• Nasal congestion
• Back pain
• Joint aches
• Constipation

Because this medication changes your blood sugar, you may experience hypoglycemia (low blood sugar) while taking it. Your healthcare provider will give you instructions on what to do.

Typically, if your blood sugar level is between 55 and 69mg/dL, you should consume some form of glucose, such as four ounces of juice, and recheck after 15 minutes. If your blood sugar is less than 55 mg/dL, let those around you know. You'll need a glucagon injection and emergency care afterward.

Symptoms of hypoglycemia include:

• Dizziness/lightheadedness
• Headache
• Shakiness
• Numbness/tingling around mouth
• Sweating
• Weakness
• Pale skin
• Changes in behavior or mood

Severe

If you have severe symptoms of hypoglycemia, those who are with you should call 911. Severe symptoms include:

• Confusion
• Seizures
• Loss of consciousness

Warnings and Interactions

In severe cases, hypoglycemia can lead to seizures and can be life-threatening. The risk for hypoglycemia may increase with changes to meal patterns, physical activity levels, and use of other medications.

In addition, meglitinides have the potential to cause interactions with other medications. For instance, repaglinide should not be taken together with gemfibrozil or clopidogrel, since they can increase the dosage exposure. Some drugs can increase the risk of hypoglycemia when taken with meglitinides, including nonsteroidal anti-inflammatory drugs (NSAIDs).

It is important for people who take meglitinides to review all of their current medications with their healthcare providers. People with diabetes should also talk to their healthcare providers before taking any over-the-counter medications or herbal supplements.

Summary

Meglitinides are medications that treat type 2 diabetes. Repaglinide and nateglinide stimulate beta cells in the pancreas to produce more insulin. This helps the body process glucose and lower blood sugar levels. They are usually taken 15 to 30 minutes before each meal.

Because meglitinides change blood sugar, it's possible to develop hypoglycemia (low blood sugar). Follow your doctor's instructions on how to treat hypoglycemia. Severe symptoms require emergency care.