Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching when the client states:
A. “It’s best if I take the drug with the first bite of a meal.”
B. “The drug makes my pancreas release more insulin.”
C. “I should never take insulin while I’m taking this drug.”
D. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
Correct Answer: D. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a product containing table sugar when treating hypoglycemia. Acarbose is FDA approved for the treatment of adults with type 2 diabetes mellitus as an adjunct to diet only or diet and exercise, depending on the patient’s health status.
Option A: The client should take the drug at the start of a meal, not 30 minutes to an hour before. Acarbose is a commonly used medication for the management of type 2 diabetes mellitus. While the drug is useful, it is not a great agent when used as monotherapy. Because the drug works in the gastrointestinal system, it’s most common adverse effects are gastrointestinal upset/bloating.
Option B: The alpha-glucosidase inhibitors work by delaying the carbohydrate digestion and glucose absorption. Acarbose is a complex oligosaccharide that acts as a competitive, reversible inhibitor of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase. By delaying the digestion of carbohydrates, acarbose slows glucose absorption, resulting in a reduction of postprandial glucose blood concentrations.
Option C: It’s safe to be on a regimen that includes insulin and an alpha-glucosidase inhibitor. If a patient experiences hypoglycemia while taking acarbose in combination with other anti-diabetic medications, the patient should receive instructions to use glucose (gel, tablets, etc.) as acarbose will prevent the breakdown of sucrose (table sugar) and delay glucose absorption, therefore, failing to correct hypoglycemia quickly. Severe hypoglycemia may require intravenous glucose or intramuscular glucagon administration.
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