Prandin (repaglinide) and Starlix (nateglinide) are currently the only FDA-approved meglitinide class drugs in the United States. Like AG inhibitors, they are taken at mealtimes (usually about 15 minutes before eating) to prevent a postprandial (after-meal) blood sugar rise. People who tend to test high after meals may benefit from treatment with meglitinide drugs.

Prandin is also FDA-approved for use with the insulin sensitizers Actos (pioglitazone) and Avandia (rosiglitazone) and for use with metformin. Starlix is cleared for use with metformin.

How They Work

Meglitinides are short-acting oral hypoglycemic agents that bind to and stimulate the insulin-producing beta cells of the pancreas. Taken before a meal, meglitinides can boost what is known as first-phase insulin release, the production of insulin that is a response to the initial boost of carb-generated blood glucose after a meal. Both Prandin and Starlix can be taken anytime from right before up to 30 minutes prior to a meal.

Possible Side Effects

Hypoglycemia can occur as a side effect of the meglitinide drugs. Symptoms of a low blood glucose episode include sweating, shakiness, dizziness, increased appetite, disorientation, heart palpitations, nausea, fatigue, and weakness. Hypoglycemia should be treated immediately with a fast-acting carbohydrate.

Patients new to type 2 medications may also experience weight gain with meglitinides. These are the most commonly reported side effects occurring with meglitinide drugs:

  • Cold and flu symptoms

  • Headache

  • Diarrhea and other gastrointestinal complaints

  • Joint and back pain

If you take a meglitinide drug, you should monitor your blood glucose levels either one or two hours after eating to ensure your medication is working properly. If blood sugar readings still seem too high, talk to your doctor about adjusting your dose.

If I skip a meal, should I still take my meds?

Try not to skip meals, as it's hard on blood glucose control. That said, it depends on the type of medication you take and when you take it. If you take an AG inhibitor or a meglitinide, you should skip the dose and take the next one with your next meal. As always, talk to your doctor about your specific situation.

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