Alpha-glucosidase inhibitors

What are alpha-glucosidase inhibitors and how do they work?

The active ingredients from the group of alpha-glucosidase inhibitors inhibit enzymes in the intestine that break down carbohydrates ingested with food into dextrose (glucose). As a result, the blood sugar rises slowly after eating.

When eating foods with a high sugar content (lemonade, cola, cake) or even pure grape sugar, the alpha-glucosidase inhibitors have no effect and the blood sugar level rises immediately. These have no effect on the release of insulin by the pancreas.

In long-term studies, however, a long-term benefit in diabetes and effectiveness against diabetes-related diseases could not be proven. Only the blood sugar peaks are balanced with both drugs, so that the remaining function of the pancreas is given a chance. More than 30% of the diabetes patients in a study discontinued the medication because of undesirable and unpleasant effects in the gastrointestinal tract.

Indications

Alpha-glucosidase inhibitors, such as acarbose and miglitol, are drugs that deactivate the enzyme alpha-glucosidase in the human intestine. This enzyme breaks down the sugar that is ingested with food. As a result, the sugar can no longer be broken down and absorbed as well. In this way, the increase in blood sugar after a meal is delayed or the peak is reduced. In the long term, this also leads to a decrease in fasting blood sugar.

They are, so to speak, a dietary supplement that should always be taken immediately before eating. The alpha-glucosidase inhibitors are mainly used in patients with type 2 diabetes who have developed resistance to the blood sugar-lowering hormone insulin.
Alpha-glucosidase inhibitors can also be used to prevent diabetes from developing.

Since alpha-glucosidase inhibitors are rather weakly effective drugs, they should always be combined with a diabetes-appropriate diet. Usually they are given in addition to other medications, e.g. B. sulfonylureas used.

Find out more about the topic here Insulin resistance and the optimal therapy

dosage

At the beginning of therapy with alpha-glucosidase inhibitors, one should start with a low dose, which can be increased as required and tolerated. The two most common inhibitors, acarbose and miglitol, are available in the form of divisible tablets of 100 mg each.

You can start with 50mg three times a day. After a few weeks, if tolerated well, the dose can be doubled. Sensitive patients should start with 50mg twice a day. The dose should be increased carefully. The tablets should be taken regularly before meals, as they only have an effect on the meal afterwards.

Overdosing can lead to diarrhea and severe flatulence.

Read more on the subject here Acarbose and how it works.

Side effects

The alpha-glucosidase inhibitors slow down the intestinal enzyme to digest the carbohydrates. The carbohydrates that remain in the intestine are instead broken down by bacteria in the colon. In the process, gases develop that inflate the intestines and lead to unwanted escape of winds. In addition, the enzyme inhibition leads to lively bowel noises and diarrhea. Such "side effects" occur in more than 50% of those treated and often lead to unauthorized discontinuation of the medication.

Alpha-glucosidase inhibitors are broken down in the liver and can affect how the liver works. Your doctor should therefore check your liver values ​​with a blood test every 3 months. If you feel unwell after taking alpha-glucosidase inhibitors, if you feel sick, vomit, or have yellowing of your eyes or skin, you should see your doctor immediately for a liver examination.

Contraindications

If you already have an intestinal disease such as Crohn's disease or ulcerative colitis, alpha-glucosidase inhibitors should not be taken in order not to put even more strain on the intestinal structures.
Since the general pressure in the abdomen also increases due to the increased formation of gas in the intestine, alpha-glucosidase inhibitors should not be used in hernias (inguinal hernia, hub hernia, diaphragmatic hernia). Heart problems can also prohibit the use of alpha-glucosidase inhibitors.

Your doctor will discuss a cost-benefit analysis with you. In severe kidney dysfunction, alpha-glucosidase inhibitors must be avoided at all costs in order to avoid a deterioration in organ function.

If, for professional or private reasons, you want to avoid an overproduction of intestinal gases and the sometimes involuntary loss of winds, the use of alpha-glucosidase inhibitors is not recommended.

Possible interactions

Drug interactions

If you take alpha-glucosidase inhibitors and another blood sugar-lowering drug, the risk of low blood sugar (known as hypoglycaemia) increases.
The need for insulin decreases with the additional intake of alpha-glucosidase inhibitors, since a steep rise in blood sugar is suppressed from the start.

Interactions with alcohol

Specific interactions between alcohol and alpha-glucosidase inhibitors are not known. Nevertheless, caution should be exercised with alcohol for patients with type 2 diabetes!
Alcohol blocks the liver from making glucose, which lowers blood sugar levels. This can lead to hypoglycaemia even hours after drinking alcohol.

This does not have to mean that diabetics have to completely avoid alcohol. Every now and then you can consume moderate amounts (for women up to 10g / day, for men up to 20g / day; corresponds to a 0.33l beer or a glass of wine) in connection with meals rich in carbohydrates. This hardly has a noticeable effect on blood sugar.

The costs

Alpha-glucosidase inhibitors are only available with a prescription in Germany. Both miglitol and acarbose can be bought in large and small packs.
Acarbose is currently available in packs of 21 and 105, miglitol in packs of 30 and 120.

The prices are similar, but in most cases the costs are covered by the health insurance company up to a deductible of 10% or at least € 5.

Alternatives to an alpha-glucosidase inhibitor

In addition to the alpha-glucosidase inhibitors, there are a few other drugs that can be used to fight diabetes and lower blood sugar.
The simplest option is insulin, which is injected under the skin and, as a hormone, directly lowers blood sugar. Insulin facilitates the absorption of sugar into the liver cells and also inhibits the supply of new sugar in the liver.

The sulfonylureas, which include metformin, for example, stimulate the insulin-producing B cells in the pancreas and in this way also reduce blood sugar.
With the help of so-called SGLT2 inhibitors, the reabsorption of sugar in the kidneys can also be inhibited, thus increasing the excretion via the urine.

More information on the topic insulin can be read here.

Use during pregnancy and breastfeeding

Alpha-glucosidase inhibitors are not recommended for pregnant women and mothers who are breastfeeding.
Children and young people under the age of 18 should also avoid it. Unfortunately, there is too little or hardly any experience as to the extent to which alpha-glucosidase inhibitors affect the development of the human body.

In addition, the use of alpha-glucosidase inhibitors should also be avoided in the case of inflammatory bowel disease, severe renal insufficiency and existing hernias (see contraindications above).

Note: hypoglycaemia

If you should ever experience hypoglycaemia while taking alpha-glucosidase inhibitors and another blood sugar-lowering drug, you cannot simply use sugar cubes to compensate for it. In this case, you need to take pure glucose to bring blood sugar levels back to normal.
Taking activated charcoal or medication against high blood lipids (colestyramine) can weaken the effects of alpha-glucosidase inhibitors.

Hypoglycaemia - What To Do? Read more here.