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Type 2 Diabetes – Glipzide and Starlix

When a person is managing their type 2 diabetes with diet and exercise, this might not be enough, and their medical team might need to prescribe an oral agent, such as a biguanide (Metformin). But with time, if this treatment does not seem to be enough, they may be prescribed additional oral agents to help bring about normal glucose levels.

This is a normal part of the progression of type 2 diabetes and should not be seen as a personal failure, or as something shameful. The goal of managing type 2 diabetes is to bring about healthy, normal glucose levels – not to be medication free.

What sort of other oral agents might one’s medical team prescribe?

Sulfonylureas and Meglitinides

If a patient needs the help of an extra oral agent, or is not able to take Metformin – their medical team might consider prescribing a sulfonylurea (such as Glipzide) or a meglitinide, which are a form of fast acting oral agents. Sulfonylureas work by binding themselves to special receptors within beta cells (the cells within the pancreas which produce insulin), and then stimulate the pancreas to produce more insulin. Sulfonylureas only help increase insulin production; they do not help alleviate or improve insulin resistance. Often, and because of this, they are prescribed in combination with other oral agents such as Metformin.

Sulfonylureas offer more convenient dosing – they are smaller, and easier to swallow, and their fast acting nature means they do not need a cumulative time period like Metformin in order to show results. Sulfonylureas are the fastest acting oral agents on the market. They have a lesser risk for gastric issues, and present no ill effects on blood pressure or LDL cholesterol, like some of the more potent medications.  And like Metformin, sulfonylureas are also low cost.

Common concerns and complications include a higher risk for hypoglycemia, a slightly higher risk of heart disease, and slight risk of weight gain (4 lbs on average). Persons allergic to sulfas may not take sulfonylureas.

Meglitinides (Starlix) are very similar to sulfonylureas. They work in the same way, by binding themselves to receptors within the beta cells (though more loosely).  Because of this, meglitinides work relatively quickly, do not stay in the system for very long, and need to be taken within 30 minutes of consuming a meal. This presents a more convenient dosing for folks who may not be able to eat on a fixed schedule.

Meglitinides might be an alternative for persons who are allergic to sulfas, and they also present lesser issues with weight gain, and hypoglycemia.

Short Treatment Life

Because of the nature of how sulfonylureas and meglitinides work – by binding themselves to receptors within the insulin-producing beta cells in the pancreas, their effectiveness tends to decrease with the progression of type 2 diabetes. As more and more insulin-producing beta cells die off, the fewer receptors there are for the medications to bind themselves. These medications are therefore, not helpful for persons who have stopped producing insulin, or who have lost most of their pancreas’ beta cells. Typically, treatment duration might average a lifespan of 5 years.

But there are other oral agent treatment plans available for people with type 2 diabetes, and all patients should consider researching, and having a conversation with their medical team about their choices, and their various health concerns.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.