Insulin Alpha-glucosidase inhibitors

Insulin Exenatide is not a substitute for insulin in insulin-requiring patients. Do not use exenatide in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. The concurrent use of exenatide with insulin, thiazolidinediones, D-phenylalanine derivatives, meglitinides, or alpha-glucosidase inhibitors has not been studied. 

When acarbose is combined with insulin, the greatest effects are seen with regimens that involve only once- or twice-daily administration. The alpha-glucosidase inhibitors seem to be less effective when they are combined with intensive insulin therapy (35). In combination with insulin or oral hypoglycemic drugs the frequency of hypoglycemic episodes can increase sucrose or higher carbohydrates are reported to be less effective, which can be understood from the mechanism of action. 

Mitrakou A, Tountas N, Raptis AE, Bauer RJ, Schulz H, Raptis SA. Long-term effectiveness of a new alpha-glucosidase inhibitor (BAY ml099—miglitol) in insulin-treated type 2 diabetes mellitus. Diabet Med 1998 15(8) 657-60. 

Trade names Glucobay Glumida Prandase Precose (Bayer) Indications Non-insulin dependent diabetes type II Category Alpha-glucosidase inhibitor Half-life 2.7-9 hours... 

Miglitol is an alpha-glucosidase inhibitor that inhibits intestinal enzymes that digest carbohydrates, thereby reducing carbohydrate digestion after meals, which lowers postprandial glucose elevation in diabetics. It is used in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have failed dietary therapy. It may be used alone or in combination with sulfonylureas. 

Acarbose is an alpha-glucosidase inhibitor that slows the breakdown of complex carbohydrates in the intestine. Thus, increases in postprandial serum glucose are inhibited, resulting in both a decrease in insulin requirement and a decrease in insulin receptor stimulation. 

Rosenthal JH, Mauersberger H. Effects on blood pressure of the alpha-glucosidase inhibitor acarbose compared with the insulin enhancer glibenclamide in patients with hypertension and type 2 diabetes mellitus. Clin Drug Invest 2002 22(10) 695-701. 

While biguanides, alpha-glucosidase inhibitors, and glitazones are not likely to cause hypoglycemia after acute overdose, they may contribute to the hypoglycemic effects of sulfonylureas, meglitinides, or Insulin. 

The pharmacokinetic changes seen are minor and unlikely to be clinically relevant. The manufacturers say that while alpha glucosidase inhibitors such as acarbose and miglitol do not cause hypoglycaemia when given alone, they may increase the blood glucose-lowering effects of insulin and... 

Normally, a controlled diet and exercise should help maintain normal blood glucose levels. When these are not sufficient, medication may need to be prescribed. Medications available today either increase the insulin supply (such as sulfonylureas, secretagogues), decrease the insulin resistance, or improve its effectiveness (biguanides and thiazolidinediones) [15]. Another group of medications is called alpha-glucosidase inhibitors, which reduce the rate of glucose absorption. 

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