Insulin Secretagogues: these are tablets that help the beta-cells in the pancreas (the cells that make and release insulin) to make more insulin. In type 2 diabetes, the beta-cells are destroyed over time so the cells do not make enough insulin to control blood sugar (glucose) levels. Insulin secretagogues help the beta-cells to make and release more insulin to help lower the blood sugar (glucose) levels.
There are different types of insulin secretagogues:
- Sulphonylureas;
- Meglitinides (glinides);
- DPP-4i (dipeptidyl peptidase 4 inhibitors or gliptins)
Sulphonylureas and Meglitinides have a direct effect on the beta-cells of the pancreas. These drugs attached onto special receptors on the edge of the beta-cells and stimulate the beta-cell to produce and release more insulin. Although these drugs increase the amount of insulin when the blood sugar (glucose) level is high, they don’t “switch – off” completely when blood sugar (glucose) levels return to normal, and these drugs can increase the risk of developing hypoglycaemia (low blood glucose).
Sulphonylureas and Meglitinides should always be taken with food, and once you have taken these tablets you should not miss any meals and or snacks.
DPP-4i are drugs that have an “indirect” effect on the beta-cells. When we eat food, the gut releases hormones called incretins, which are sent to the pancreas to help the beta-cells to produce more insulin, as well as to release hormones from cells called the alpha-cells, that prevent the liver from producing too much glucose (sugar). The body produces enzymes that break down the incretin hormones very quickly so that in people with type 2 diabetes these hormones don’t work properly. DPP-4i drugs inhibit these enzymes from breaking down the incretin hormones so that they can continue to work and help lower blood glucose levels.
DPP-4i, when they are used on their own, have a very low risk of hypoglycaemia as they only work when you have eaten food.