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). [link to terminology]

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.