Alpha-Glucosidase Inhibitors
Alpha-Glucosidase Inhibitors
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Wednesday, February 22, 2006 |
Q: "How do Glyset® and Precose® work?"
A: Precose (Acarbose tablets) and Glyset (Miglitol tablets) are both from the class of drugs called alpha-glucosidase inhibitors. I'll refer to these drugs as AGIs for this answer.
In previous answers about oral agents, I reviewed how insulin works, and I described the defects in type 2 diabetes, as well as how each oral agent targeted a different defect.
How AGIs Work:
AGIs slow the rise in your post-meal blood glucose-i.e. they decrease the peak in your blood glucose by delaying the absorption of certain sugars and starches into the bloodstream. They do this by slowing the digestion of carbohydrates in the small intestine. Note: Because AGIs do not stimulate the pancreas to produce more insulin, then when used alone, they will not cause hypoglycemia. However, if used in combination with some other diabetes medications, hypoglycemia can occur.
Side Effects:
While these drugs are generally safe, they can cause some gastrointestinal side effects: intestinal gas (called flatulence), stomach upset, abdominal pain, and diarrhea. These side effects are due to the way AGIs work, and are not considered serious health concerns. Because AGIs change the way your body digests the food you eat, it takes time for your body to adjust to this change. If gastrointestinal side effects do occur, they usually develop during the first few weeks of therapy, and usually diminish with time (4-8 weeks). You should not use these drugs if you have any of the following conditions: certain diseases of the stomach and intestines (such as inflammatory bowel disease), pregnancy; or significant kidney disease.
When do you take AGIs:
These pills are taken with the first bite of the meal, so generally they are taken 3-times a day. However, to minimize side effects, generally a gradual dosing schedule will be provided by your doctor. If you forget to take your pill, don't take it later-but rather, just take your regular dose at the start of your next meal. Do not double up at the next meal. Be sure to note the missed dose in your glucose record book. And if you skip a meal, do not take AGIs alone, since they only work with food.
Other Effects or Interactions:
As already mentioned, AGIs do not cause hypoglycemia; however, if AGIs are taken with some other diabetes medications (pills or insulin), there could be a further lowering of your blood glucose and hypoglycemia could occur. Important note: AGIs inhibit the enzyme that breaks down certain sugars (disaccharides), such as sucrose, which would be contained in soft drinks, fruit punches, and other sweetened drinks. So if you were on a combination of diabetes medications including AGIs and if you experienced hypoglycemia, you must treat the hypoglycemia with a monosaccharide type of sugar food such as:
- Glucose tablets
- Glucose gel
- Real fruit juice (not fruit drink or fruit punch)
- Milk (even though milk is a disaccharide, the enzyme in milk is not inhibited by AGIs).
Do not use: table sugar, diet or regular soda, candy, jelly, or syrup. This is because AGIs would delay the absorption of these types of sugars, and thus would not provide rapid or adequate relief from the hypoglycemia.
Conclusion:
Finally, remember that meal planning, regular activity, and glucose monitoring are still the cornerstones of good diabetes management, and that diabetes pills are another tool to help you keep your diabetes in good control.
Be sure to discuss all your medications, side effects, safety precautions, and possible interactions with your physician.
Related Links
American Diabetes Association (ADA)
http://www.diabetes.org
National Institute of Diabetes & Digestive & Kidney Diseases
(NIDDK)
http://www.niddk.nih.gov
Drug Information Online
http://www.drugs.com
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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