Prandial Glucose Regulators

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Prandial glucose regulators are a group of oral medications used in the treatment of type 2 diabetes. They act to increase your body’s natural insulin production and help limit blood sugar spikes at mealtimes.

What are prandial glucose regulators?

Prandial glucose regulators are a family of drugs that stimulate your pancreas to produce more insulin. In medical terms, prandial means ‘of or relating to a meal’. It follows that prandial glucose regulators work to control sugar levels at mealtimes.

The group of medications is alternatively known as meglitinides or glinides. It includes the drugs Repaglinide, also known by its brand name Prandin, and Natemeglitinide, also known as Starlix.

Prandial glucose regulators act similarly to sulfonylureas- but their effect has a more rapid onset and lasts for a shorter time. Your doctor will usually recommend that you take a prandial glucose regulator up to three times a day, around thirty minutes before eating, to prevent your blood sugar from surging after your meal.

How do prandial glucose regulators work?

Prandial glucose regulators act on the insulin-producing cells in the pancreas, stimulating them to produce more of the hormone insulin. The drugs bind to proteins in the beta cells of the pancreas, triggering insulin release. As a result, there’s more insulin in your bloodstream, which helps to reduce blood glucose levels.

Your body’s need for insulin is highest with meals. In non-diabetic people, insulin secretion increases rapidly after eating, reaching peak levels within an hour. This mealtime response is delayed and reduced in people with type 2 diabetes. Prandial glucose regulators can help your body replicate this natural pattern of insulin release.

Glinides work in a similar way to sulfonylureas, but their quick action and short-term effect make meglitinides beneficial for people who struggle to plan meals, have changeable routines, eat irregularly or work shifts.

You should only take your prandial glucose regulator within half an hour of eating. You should skip the medication if you skip a meal, or your blood glucose could fall too low.

Who should take prandial glucose regulators?

In general, the first lines of treatment for type 2 diabetes include lifestyle measures such as eating a healthy diet, increasing exercise and aiming for a healthy BMI.

People with type 2 diabetes that isn’t controlled by lifestyle changes are usually offered oral medications. The first drug offered is usually Metformin, which helps your body respond to the insulin it produces, reduces the glucose produced by your liver, and decreases glucose absorption in the gut.

Prandial glucose regulators can benefit some people living with type 2 diabetes where Metformin is not controlling their diabetes. Your doctor may prescribe one in combination with Metformin if your HbA1c levels are above the guideline target of 6.5% or 48 mmol/mol and your lifestyle is not routine.

The National Institute for Health and Care Excellence (NICE) says that these drugs are a less preferred option than sulfonylureas but are helpful because they can be used flexibly and adjusted to fit individual eating habits.

Side-effects of prandial glucose regulators

All medications have side effects. In general prandial glucose regulators are safe; however, they do have some adverse effects, including:

  • Hypos, especially if you skip a meal. The effects of glinides are rapid. If your blood glucose falls too low, you may experience symptoms of hypoglycaemia, including shaking, dizziness, sweating, mood changes, hunger and tiredness. If not treated promptly, a hypo can lead to coma, reduced consciousness and even death. However, research suggests that prandial glucose regulators are less likely to cause hypos than sulfonylureas
  • Rashes and allergic skin reactions
  • Liver problems
  • Abdominal pain
  • Nausea
  • Bowel disturbance, including diarrhoea and constipation

Advantages of prandial glucose regulators

Prandial glucose regulation with a glinide medication can improve metabolic control in people living with type 2 diabetes. The other advantages include:

  • Improved management of blood glucose levels and decreases in the HbA1c
  • Reduced spiking of glucose after meals
  • The medication is generally well-tolerated, and adverse reactions are uncommon
  • Glinides don’t tend to cause weight gain
  • Patients taking glinides are less likely to have hypos than with sulfonylureas
  • The flexibility of pre-meal medication can allow greater freedom and spontaneity, which many patients appreciate

In research, prandial glucose regulators were found to be effective and well-tolerated. Patients responded to treatment positively, with the vast majority choosing to continue their treatment after the trial. Prandial glucose regulation was described as convenient, and the effects on diet and lifestyle were liberating.


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