A prandial glucose regulator
Repaglinide
A short-acting tablet that lowers blood sugar after meals in type 2 diabetes, taken before eating.
What is Repaglinide?
Repaglinide is a tablet for type 2 diabetes that helps the body release a quick burst of insulin to handle the sugar from a meal. It works fast and wears off quickly, so it is taken shortly before each main meal — and importantly, skipped if you skip a meal. Because it raises insulin, it can cause low blood sugar (a hypo), so it is useful to know the signs. It is often chosen for people with irregular meal patterns or who cannot take metformin.
Education and reference only. This is a plain-language guide to Repaglinide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Repaglinide is an oral medicine for type 2 diabetes belonging to a group called meglitinides, or prandial glucose regulators. It encourages the pancreas to release insulin in response to a meal, helping to control the rise in blood sugar that follows eating. It acts quickly and does not last long in the body, which is why it is taken with meals rather than at fixed times. It is taken as a tablet and is often used when metformin is unsuitable or alongside other diabetes treatments.
How it works
Repaglinide acts on the insulin-producing cells of the pancreas, prompting them to release a short, well-timed burst of insulin when a meal is eaten. This insulin helps move sugar from the bloodstream into the body's cells, limiting the spike in blood sugar after eating. Because it works fast and clears quickly, its effect is tied closely to mealtimes, which is why each dose is taken just before a meal and left out if that meal is missed.
Company & origin
Originated / developed by: Generic (long-established).
A fast-acting tablet used in the UK to help control blood sugar in type 2 diabetes, taken just before meals.
What it treats
Conditions Repaglinide is used for
Practical use
How to take Repaglinide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take a dose shortly before each main meal, usually within a short time of starting to eat.
- If you skip a meal, skip that dose — do not take it without food, as this can cause low blood sugar.
- If you add an extra meal, you can usually take an extra dose before it, as advised by your prescriber.
- Learn the signs of a hypo (shakiness, sweating, hunger, confusion) and carry a fast-acting sugar source.
- Take it as prescribed and do not double up if you miss one; just take the next dose with your next meal.
- Tell your prescriber about other medicines, as some can strengthen or weaken its effect on blood sugar.
Weighing it up
Advantages & disadvantages of Repaglinide
Advantages
- Its fast, meal-by-meal action suits people with irregular or unpredictable mealtimes.
- Targets the rise in blood sugar after eating, which is helpful when this is the main problem.
- Can be used when metformin is unsuitable, or added alongside it.
Disadvantages
- Can cause low blood sugar, especially if a meal is delayed, smaller than usual or missed.
- Needs to be taken with every main meal, which means several doses a day.
- May cause weight gain, as with other insulin-stimulating diabetes medicines.
Practical use
Good to know
The key practical point is that repaglinide is a 'one dose per meal' medicine: take it before each main meal you eat, and skip the dose if you skip the meal, otherwise blood sugar can drop too low. Because it stimulates insulin, it can cause hypos, so it helps to recognise the early signs — shakiness, sweating, hunger, confusion — and to carry something sugary. Its flexible, meal-by-meal timing suits people whose mealtimes vary from day to day. It is usually used with diet and exercise, and sometimes alongside metformin. Alcohol and certain medicines can change how it affects blood sugar, so it is worth being aware of these.
Who should not take it / use with caution
- People with type 1 diabetes or diabetic ketoacidosis should not use it.
- It is generally avoided in severe liver problems and used with caution in kidney problems.
- People taking certain interacting medicines, such as gemfibrozil, should not use it together.
Monitoring
- Regular blood sugar checks and longer-term HbA1c tests to see how well diabetes is controlled.
- Watching for and acting on episodes of low blood sugar.
- Reviewing liver and kidney function where relevant, and overall treatment alongside diet and weight.
Side effects
- Low blood sugar (hypo) with shakiness, sweating, hunger or confusion is the main concern.
- Stomach upset, such as nausea, diarrhoea or constipation, in some people.
- Weight gain and, rarely, allergic skin reactions or changes in liver tests.
Key interactions
- Gemfibrozil greatly increases repaglinide levels and should not be taken with it.
- Some medicines (such as certain antifungals and antibiotics) and alcohol can increase the risk of hypos.
- Steroids, some water tablets and other medicines can raise blood sugar and reduce its effect.
Available as: Tablets taken by mouth before meals.
Answers
Repaglinide: frequently asked questions
When should I take repaglinide?
Take it shortly before each main meal. Because it works quickly to handle the sugar from food, its timing is linked to eating rather than to fixed clock times.
What if I skip a meal?
Skip that dose too. Taking it without eating can cause your blood sugar to drop too low, so it is a 'one dose per meal you eat' medicine.
Can it cause low blood sugar?
Yes. Because it makes your body release insulin, it can cause a hypo, especially if a meal is delayed or missed, so learn the signs and carry a sugary snack.
How is it different from metformin?
Metformin mainly reduces the sugar your body makes and is taken at set times, while repaglinide triggers a quick burst of insulin with each meal and is taken before eating.
Will it make me put on weight?
It can cause some weight gain, as can other diabetes medicines that increase insulin; diet, activity and regular review help manage this.
Authoritative sources
- BNF
- NICE CKS
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