If postprandial blood sugar is not well controlled, what should I pay attention to when taking acarbose?

A diabetic patient left a message to Huazi, saying that he took metformin and basal insulin every day, but his blood sugar after meals was always around 13mmol/L and was not well controlled. What should he do? Huazi suggested that he go to the doctor and take acarbose under the doctor's guidance to improve the control of blood sugar after meals.

However, when taking acarbose, some side effects may occur, and some precautions need to be known in advance.

1. Acarbose mainly reduces postprandial blood sugar

Most patients with type 2 diabetes are most familiar with two oral hypoglycemic drugs, one is metformin and the other is acarbose. Metformin is a drug that runs through the entire course of diabetes treatment. As long as there are no related contraindications, it is recommended that patients with type 2 diabetes take it throughout the course of the disease. Acarbose, on the other hand, is mainly used to lower postprandial blood sugar.

Acarbose is an α-glucosidase inhibitor, and its similar drugs include voglibose, miglitol, etc. The mechanism of action of this type of drug is to inhibit the activity of disaccharide hydrolase α-glucosidase in the intestine, thereby slowing down the decomposition of polysaccharides such as starch in food into disaccharides (such as sucrose) and monosaccharides (glucose), delaying the absorption of glucose, and thus reducing the peak blood sugar level after a meal.

2. Acarbose can be used in combination with other hypoglycemic drugs

α-glucosidase inhibitors, represented by acarbose, only work in the intestines and generally do not cause hypoglycemia when used alone. In terms of hypoglycemic effect, α-glucosidase inhibition can reduce glycated hemoglobin (HbA1c) by an average of 0.5% to 0.8%, and will not increase body weight. It may even cause weight loss, making it suitable for obese diabetic patients.

However, acarbose only has a greater effect on postprandial blood sugar. If the patient's pancreatic islet function is poor, taking acarbose alone will not bring blood sugar up to standard. Therefore, acarbose is often used in combination with other hypoglycemic drugs such as metformin, insulin secretagogues, insulin sensitizers and insulin.

3. Correctly view the side effects of acarbose

Because acarbose slows down the digestion of carbohydrates and causes them to remain in the intestines for a long time, digestive tract reactions are the most common side effects of taking acarbose. In the early stages of medication, you may experience abdominal pain and diarrhea. Due to the fermentation of intestinal bacteria, a large amount of gas is produced, leading to bloating and increased flatulence.

However, this situation is a "good thing" because carbohydrate foods retained in the intestines are a kind of "nutrient" that can promote the reproduction of probiotics. Through the restrictive effect between bacteria, it can inhibit the growth and reproduction of harmful bacteria in the intestines, thereby promoting intestinal health and preventing intestinal diseases and colon cancer.

4. Precautions for using acarbose

1. Dosage: Acarbose 50 mg per tablet, 1-2 tablets at a time, start with a small dose, 3 times a day, with meals.

2. Time of taking: It should be taken at the same time as the first bite of food, because acarbose needs to be present in the small intestine together with carbohydrates to exert its efficacy. If the medicine is taken before or after a meal, the blood sugar-lowering effect will be reduced or even ineffective.

3. Rare side effects: Most of acarbose works in the intestines, and only 1% to 2% is absorbed, so there are usually no systemic adverse reactions. However, some patients may experience asymptomatic elevation of liver enzymes, and very few may experience jaundice or liver damage.

4. Impact on digoxin absorption: For patients with concomitant heart failure, if they are taking digoxin at the same time, acarbose will reduce the absorption of digoxin. Therefore, people taking digoxin should avoid using acarbose.

5. Rescue in case of hypoglycemia: Acarbose usually does not cause hypoglycemia when used alone, but when used in combination with other hypoglycemic drugs, if the adverse reaction of hypoglycemia occurs, it should be noted that glucose should be consumed directly to rescue. The rescue effect of ordinary sucrose or rice and noodles is very poor because α-glucosidase is inhibited and glucose cannot be decomposed.

To sum up, acarbose is a "weapon" for lowering postprandial blood sugar, especially suitable for Chinese people whose staple food is starchy foods such as rice and noodles.

When using acarbose, pay attention to the requirements for medication time, gastrointestinal reactions that may occur in the early stage of medication, and rescue methods when hypoglycemia occurs.

Medication should be used under the guidance of a doctor. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.