Almost all of the nutrients you get from your diet—including glucose—are absorbed into the blood in the small intestine. Your digestive system breaks down complex carbohydrates, such as lactose, starches, and sucrose found in food, into monosaccharides such as glucose and fructose. The body then absorbs glucose through the intestinal walls. In a healthy person, regular glucose absorption rates are fine—a healthy person’s body can easily handle the normal amount of glucose absorbed in the intestines. For those with type 2 diabetes, however, even standard absorption rates can become problematic, as once that glucose is taken into the bloodstream, it sits there unused, and can cause dangerous complications down the road.
Therefore, the treatment of diabetes often relies on the use of medications that prevent the absorption of glucose through the small intestines, thus keeping it out of the blood. Drugs that prevent the body from absorbing glucose include alpha-glucosidase inhibitors and pramlintide.
Acarbose and Miglitol: Alpha-Glucosidase Inhibitors
Alpha-glucosidase inhibitors are designed for use in conjunction with sulfonylurea drugs, such as glipizide, glimepiride, and glyburide, or with metformin. Always take your alpha-glucosidase inhibitor with the first bite of each meal, as directed by your doctor. If you fail to take this medication with the first bite of the meal, you greatly decrease its effectiveness. Use of this type of medication is typically reserved for people with type 2 diabetes who have trouble controlling their blood sugar levels after eating meals high in complex carbohydrates.
Types of Alpha-Glucosidase Inhibtors
The two commonly prescribed types of alpha-glucosidase inhibitors are:
- acarbose (Precose)
- miglitol (Glyset)
How Acarbose and Miglitol Work
Alpha-glucosidase inhibitors help keep your blood sugar levels from spiking too far after meals by slowing the digestive process for complex carbohydrates (i.e., starches). Common foods containing complex carbohydrates include grains, cereal, breads, flower, beans, rice, starchy vegetables, and potatoes. Alpha-glucosidase inhibitors do not, however, stop or slow the absorption of some of the simple sugars found in foods such as fruit, desserts, candy, and honey.
Acarbose and Miglitol Side Effects and Risks
Alpha-glucosidase inhibitors can cause side effects for some people, including:
- abdominal distention
- increased liver enzyme levels
- severe allergic reaction
This class of medication can also interact negatively with other drugs and dietary supplements, such as:
- other diabetes medications
- seizure medications
- thyroid replacement hormones
- over-the-counter cold medications
Alpha-glucosidase inhibitors are not ideal for everyone. If you have severe digestive disorders or liver disorders, chances are your doctor will suggest an alternative. They are also not usually prescribed to women who are currently lactating or to children.
What The Expert Says
“One of the biggest advantages of alpha-glucosidase inhibitors is that they help decrease the amount of insulin your body needs after meals. This is advantageous because elevated post-meal insulin levels are associated with increased heart disease risk,” explains Dr. Michael Hall, a family physician for DuBois Regional Medical Center in DuBois, Pennsylvania. However, Hall warns that alpha-glucosidase inhibitors are not as effective when taken as the only diabetes medications. They work best when paired with other diabetes medications, such as insulin, metformin or sulfonylureas.
How Pramlintide Works
Pramlintide helps slow the absorption of glucose by decreasing the speed at which food leaves your stomach. It also diminishes your appetite and increases feelings of satiety (fullness). Together, these two things help reduce the amount of carbohydrates you consume and decrease the speed at which your body absorbs glucose through the intestinal walls. Pramlintide works by mimicking the action of the hormone amylin in your body. Your pancreas releases amylin each time you eat, to decrease the speed at which your stomach empties and decrease the rate glucose passes through the lining of your gut into your blood.
Pramlintide Side Effects and Risks
Pramlintide can cause some side effects, including:
- runny nose
- sore throat
- loss of appetite
- joint pain
It may also cause negative side effects if combined with other drugs. Other drugs that may interact negatively with pramlintide include:
- other glucose control medications
- cholinergic blockers for the heart
- ACE inhibitors
- cholesterol-lowering medications
- asthma medications
- birth control pills
- thyroid replacement hormones
- diet pills
- over-the-counter medications for colds or allergies
- sulfa drugs
- seizure medications
Mixing pramlintide with insulin may result in hypoglycemia. If you use insulin with pramlintide, ensure you use two different injection sites. Also, use a different injection site on your thigh or stomach each time you give yourself a pramlintide injection.
Discard any discolored pramlintide and any pramlintide that contains particles. Contact your doctor for a new prescription.
Because pramlintide delays the absorption of any drug you take orally, do not use any oral medications within one hour after using pramlintide. Talk with your doctor if this becomes an issue that affects your diabetes management plan.
Always monitor your blood sugar closely while taking pramlintide. You may experience sever hypoglycemia within three hours of taking a pramlintide injection. Common symptoms of hypoglycemia include headache, tremors, hunger, irritability, concentration problems, and sweating. If you check your blood sugar and find you have hypoglycemia, eat some hard candy or eat glucose tablets. Discuss your care with your friends and family to ensure they know what to do in case of an emergency. If your blood sugar levels drop too low, you risk losing consciousness, experiencing seizures, or even dying.
What The Experts Say
People with diabetes who require insulin to control their blood glucose levels may benefit from adding pramlintide to their treatment plan. Pramlintide promotes both blood glucose control and weight loss. “Together, [these benefits] may address an important deficit in the treatment of diabetes,” according to an article published in the September 2006 issue of Vascular Health Risk Management. The deficit lies in the fact that other diabetes treatments often result in weight gain and increased cardiovascular risk, instead of weight loss and decreased cardiovascular risk.