Acarbose 💊
Important: Acarbose does not cause hypoglycaemia on its own, but it may worsen hypoglycaemia when combined with insulin or sulfonylureas.
⚠️ Sucrose should NOT be used to treat hypoglycaemia in patients on Acarbose, as the drug blocks its breakdown into glucose + fructose. Use pure glucose (dextrose) instead.
💊 About
- Acarbose (trade name Glucobay) is an oral hypoglycaemic agent used in Type 2 Diabetes Mellitus.
- Provides modest improvements in HbA1c (~0.5–0.8%).
- Best used in combination therapy rather than monotherapy.
⚙️ Mechanism
- Alpha-glucosidase inhibitor: competitively inhibits enzymes in the brush border of the small intestine.
- Delays carbohydrate digestion and absorption → blunts postprandial glucose rise.
- Acts locally in the GI tract (minimal systemic absorption).
📌 Indications & Dose
- Type 2 Diabetes Mellitus, especially when postprandial hyperglycaemia predominates.
- Start: 25–50 mg PO OD, titrate upwards.
- Maintenance: 50 mg TDS.
- Maximum: 100 mg TDS (depending on tolerance and efficacy).
📊 Dose Table (check BNF for confirmation)
💊 Dose Range (Always check BNF)
| Dose |
Route |
| 25–50 mg OD (starting) |
PO with food |
| 50 mg TDS (usual maintenance) |
PO with meals |
| Max: 100 mg TDS |
PO with meals |
🚫 Contraindications
- Chronic intestinal conditions: IBD, bowel obstruction, colonic ulceration.
- History of significant abdominal surgery or malabsorption syndromes.
- Severe hepatic impairment or renal failure.
- Abdominal hernia (risk of gas expansion).
- Pregnancy and breastfeeding (not recommended).
⚠️ Side Effects
- GI upset: flatulence, bloating, diarrhoea (fermentation of undigested carbs in colon).
- Reversible rise in LFTs (monitor liver function).
- Can potentiate hypoglycaemia when combined with insulin or sulfonylureas.
🔍 Clinical Pearls
- Take with the first mouthful of a meal (not before/after) for maximal effect.
- Teach patients: if hypoglycaemia occurs, use glucose/dextrose (not table sugar/s
