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- Medications for type 2 diabetes
- Meglitinides (Prandin and Starlix)
- Metformin (Glucophage)
- Canagliflozin (Invokana) and dapagliflozin (Farxiga)
- Thiazolidinediones: pioglitazone (Actos) and rosiglitazone (Avandia)
- Acarbose (Precose)
- Pramlintide (Symlin)
- Exenatide (Byetta)
- Liraglutide (Victoza)
- Long-acting exenatide (Bydureon)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- DPP-IV inhibitors (sitagliptin, saxagliptin, linagliptin)
- Combination medications
- Treatment of diabetes with insulin
- Different methods of delivering insulin
- Diabetes diet
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Meglitinides (Prandin and Starlix)
Meglitinides is a class of drugs that work by promoting insulin secretion from the pancreas, binding to a different site on the same channel complex regulated by sulfonylureas. Unlike the sulfonylureas which last longer in the body, repaglinide (Prandin) and nateglinide (Starlix) are very short acting, with peak effects within one hour. For this reason, they are given up to three times a day just before meals.
Since these drugs increase circulating insulin levels they may cause hypoglycemia. Literature suggests meglitinides cause hypoglycemia less frequently than sulfonylureas.
In a three-month study, repaglinide (Prandin) dropped fasting blood glucose values by 61 mg/dL and post-meal blood glucose values by 100 mg/dL. Because repaglinide is short-acting and given before meals, it is particularly beneficial in lowering blood glucose after meals and does not tend to lower fasting glucose levels to the same degree. Prandin has been used in combination with other medications, such as metformin (Glucophage), with impressive results. In 83 patients with type 2 diabetes, addition of repaglinide to metformin significantly improved blood sugar control.
- Rrepaglinide interacts with other medications; therefore, the health-care professional must be aware of all other medications administered to a patient.
- The usual starting dose for repaglinide is 0.5 mg before each meal, which can be increased to 4 mg. The maximum daily dose is 16 mg.
- repaglinide is used cautiously in people with kidney or liver abnormalities.
- Since repaglinide increases insulin levels, it carries risk of causing abnormally low blood sugars. Severe hypoglycemia can result in sweating, tremors, confusion, and may lead to coma and seizure.
- In addition, repaglinide has been associated with headaches, muscle and joint aches, along with sinus infections in some individuals.
- This drug should not be used in pregnancy or by nursing mothers.
- The dose may need to be adjusted in older people, since the elderly may metabolize (eliminate) medications at a slower rate.
Nateglinide (Starlix) has essentially the same profile of side effects and interactions as repaglinide. The major benefit of nateglinide is that the starting dose of 120 mg does not need to be adjusted upward, but rather remains constant. These medications are also relatively safe to use in people with impaired kidney function.