May cause hypoglycemia. Use with caution in adrenal and/or pituitary impairment (may be more susceptible to glucose-lowering effects), in moderate-to-severe hepatic impairment, and in severe renal impairment (may be more susceptible to glucose-lowering effects). It may be necessary to discontinue nateglinide and administer insulin if patient exposed to stress (i.e. fever, trauma, infection, surgery). Patients not adequately controlled on oral agents which stimulate insulin release (e.g. glyburide) should not be switched to nateglinide or have nateglinide added to therapy. Indicated for adjunctive therapy with metformin (not to be used as substitute for metformin monotherapy). Combination treatment with sulfonylureas not recommended (no additional benefit). Use with caution in the elderly and in malnourished patients (may be more susceptible to glucose-lowering effects).