Insulin Secretagogues



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Editors
Silvio Inzucchi, MD
Guillermo Umpierrez, MD
Julio Rosenstock, MD



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AADE
Mayo Clinic
NIH

What are insulin secretagogues?

Insulin secretagogues (pronounced seh-KREET-ah-gogs) are one type of medicine for type 2 diabetes. Many people with type 2 diabetes don’t make enough insulin. Insulin secretagogues help your pancreas make and release (or secrete) insulin. Insulin helps keep you blood glucose from being too high. Once your body gets the insulin it needs, you feel better. Your doctor might prescribe these insulin-releasing pills for you when you can’t reach your target blood glucose levels with a healthy diet, exercise, and other diabetes medicines.

Several other types of diabetes pills are available. Each type works in a different way. Some people take pills that combine two types of diabetes medicines. For example, some pills combine an insulin-releasing medicine with a medicine that helps your insulin work better (like pioglitazone). Another type combines an insulin releaser with a pill that keeps your liver from making too much glucose (like metformin).

Two other types of medicines, called incretin-based medicines, share some features of the insulin-releasing medicines. DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin) and GLP-1 receptor agonists (exenatide, liraglutide) raise insulin levels for a short time after you eat a meal.

Types of Insulin Secretagogues

Insulin-releasing medicines

  • Sulfonylureas (Generic names): Glimepiride, Glipizide, Glyburide
  • Meglitinides (Generic names): Repaglinide, Nateglinide

What are the benefits of insulin secretagogues?

Both types of these insulin-releasing medicines lower blood glucose levels. Sulfonylureas are low in cost and usually are well tolerated. They are taken once or twice a day. Meglitinides are designed to work with your meals and are taken right before meals (2 to 4 times a day). Meglitinides act for a shorter period of time than sulfonylureas.

What are the side effects and disadvantages of insulin secretagogues?

Both types of insulin-releasing medicines can cause blood glucose levels to be too low, a condition called hypoglycemia. Low blood glucose can make you feel hungry, dizzy, nervous, shaky, or confused. It can be especially serious in people with heart conditions and the elderly. You can learn what to eat or drink to bring your blood glucose level back up to normal.

Insulin-releasing medicines can also lead to slight weight gain. Over time, sulfonylureas may lose the ability to work well. Meglitinides need to be taken more often than sulfonylureas because they work for a shorter amount of time.

How will I know which diabetes medicines are best for me?

Talk with your doctor about your diabetes medicines. Ask whether there are other medicines that can help you. Tell your doctor about any side effects you have from your medicines. If the results of your blood glucose tests have been higher or lower than usual, talk with your doctor to help find the cause.

Questions to ask your doctor

  • What else can I do to keep my blood glucose levels under control?
  • How often should I check my blood sugar?
  • How often should I have check-up?
  • What side effects can happen with my medicines?
  • What should I do if I forget to take my diabetes medicine?
  • Should I see an endocrinologist for my diabetes care?