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Note: This is the second part of a two-part series. The first part was published in our January 2005 issue
Meglitinides and Phenylalanine Derivatives
The meglitinide class of drugs includes Prandin (repaglinide). The phenylalanine class includes Starlix (nateglinide).
As cousins to the sulfonylureas, these medications also require at least some pancreatic beta cell function to work. They stimulate insulin faster and for a shorter period of time than the sulfonylureas. Therefore, for maximum effectiveness and to minimize possible hypoglycemia, they must be taken with the first bite of every meal that contains carbohydrate.
The main benefits of these drugs is that they have less incidence of hypoglycemia and provide greater flexibility in terms of meals and exercise than the sulfonylureas. The drawbacks are that patients often forget to take them with the afternoon meal, and they are much more expensive and less potent than the sulfonylureas.
These drugs do not lower blood glucose; instead, they prevent it from rising overnight and before meals. Metformin, also marketed as Glucophage or Glucophage XR, is the only biguanide currently available in the United States. This drug reduces the amount of starch breakdown by the liver in the fasting state and for several hours after eating.
Metformin offers several unique and helpful features for patients:
The main side effects of metformin are nausea and diarrhea, which can be limited by taking it with or after meals and by starting with the lowest possible dose.
Patients with kidney or liver disease or who have a history of alcohol abuse or congestive heart failure should not take this medication.
Jan 1, 2005
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.