HYPOGLYCEMIA and meds

[Guest guest]

thanks for the drug name!!!

I know the drug. in US its " precose " generic name acarbose. Its actually a

DIABETES type 2 drug- to LOWER blood sugar levels--and sometimes, to manage

diabetic hypoglycemia when their other drugs are needed to keep the high sugars

too high BUT when the drugs lower them too much after meals.

Its an inhibitor of alpha glucosidase--aka " maltase " an enzyme needed in

biochemical usage of glucose

The intestinal mucosa naturally excretes this to  break down carbs (

disaccharides) into glucose.

Acarbose is a complex oligosaccharide that delays the digestion of ingested

carbohydrates, thereby resulting in a smaller rise in blood glucose

concentration following meals, IN DIABETICS.

manufacturer suggests LEAST dose possible and to stay below 100 mg tid for

persons weighing over 60 kg - 132 lbs-( and 50 mg tid for those weighing

less) taken at first bite of a " mixed meal " meaning with ample carbs and fats

and proteins. starting dose is 25 mg tid and slowly increased...again to insure

glucose is LOWERED.Those of us unable to eat real sized meals may have

problems--low body weight people may get elevated liver enzymes!!!

From the manufacturer:

Oral glucose (dextrose), whose absorption is not inhibited by PRECOSE ®, should

be used instead of sucrose (cane sugar) in the treatment of mild to moderate

hypoglycemia. Sucrose, whose hydrolysis to glucose and fructose is inhibited by

PRECOSE ®, is unsuitable for the rapid correction of hypoglycemia. Severe

hypoglycemia may require the use of either intravenous glucose infusion or

glucagon injection.

contraindications:

PRECOSE ® is contraindicated in patients with known hypersensitivity to the

drug and in patients with diabetic ketoacidosis or cirrhosis. PRECOSE ® is also

contraindicated in patients with inflammatory bowel disease, colonic ulceration,

partial intestinal obstruction or in patients predisposed to intestinal

obstruction. In addition, PRECOSE ® is contraindicated in patients who have

chronic intestinal diseases associated with marked disorders of digestion or

absorption and in patients who have conditions that may deteriorate as a result

of increased gas formation in the intestine.

FOR THOSE OF US WITH MALAPSORPTION---extreme caution!!

how metabolised ( broken down)

Acarbose is metabolized exclusively within the gastrointestinal tract,

principally by intestinal bacteria. A fraction of these metabolites

(approximately 34% of the dose) was absorbed and subsequently excreted in the

urine. At least 13 metabolites have been separated chromato-graphically from

urine specimens. The major metabolites have been identified as

4-methylpyrogallol derivatives (i. e., sulfate, methyl, and glucuronide

conjugates). One metabolite (formed by cleavage of a glucose molecule from

acarbose) also has alpha-glucosidase inhibitory activity. but also by digestive

enzymes. A fraction of these metabolites (approximately 34% of the dose) was

from urine specimens. This metabolite, together with the parent compound,

recovered from the urine, accounts for less than 2% of the total administered

dose. .

half life 2 hours and no accumulation. " appears " to be reversible--no permanent

change in carb metabolism after stopping it

several studies with hypoglycemia ( reactive type as in after meals) showed a

" similar result as careful dietary changes " , SO then why prescribe it??? drug

sales!!!

seems that this drug works better for " dumping syndrome " usually found in

infants and also adults who underwent gastric decreasing surgeries.

FOUR types of reactive (non fasting) hypoglycemia:

1) from early NIDDM (type II diabetes) or glucose intolerence- has HIGH  and

prolonged insulin levels

        2) alimentary hypoglycemia ( dumping) usu. from gastrectomy

        3) alcohol induced and

        4) ideopatic (a fancy word for " unknown cause " )

BE careful of asking for or having a Dr suggest the following tests:

72 hr fast, OGTT ( oral gluc tolerance test), mixed meal or pp (post prandial)

as they ALL have high rates of false pos and neg!!! and can make you severely

ILL- especially if youre not used to the very high amts of sugars they feed you.

a better strategy is " ambulatory " monitoring. You get a glucose meter as in

diabetes, and then you adjust your meals accordingly ( i.e. a hi carb meal of 75

gm carbs, a mixed meal, a low carb meal) and throughout the testing period of

1-3 weeks you then take glucose levels BUT be aware that these are most accurate

at values above 60, so IF you feel very ill and have lower readings you may need

IMMEDIATE ingestion of glucose and/or medical help!!

LOW sugar levels mean nothing UNLESS you also have sx!!! the " whipples Triad " is

used to dx a true hypoglycemia= low blood gluc, PLUS sx PLUS sx improve when

given glucose--simple!

they usually need a few a.m. fasting readings and then 1.5-2 hrs after start of

meals. This is the best and most accurate way to see what happens to YOU with

YOUR diet. and also a great way to see if diet alone will help you. AND as a

bonus, you will have " proof " of your glucose responses. and find out which sx

are truly due to low glucose. and you can take levesl during day if and when you

have sx...to sort out whats really due to low or dropping sugar

the fasting levels help see if you also or instead have 'fasting hypoglycemia'

which may be more serious!!

DRUGS that cause hypoglycemia- alcohol, Pentamidine, Beta-blockers, quinine (in

high doses), quinidine, salicylates (aspirin, especially in children),

sulfonamides, disopyramide, propoxyphene, and haloperidol.

other CAUSES:Hormone deficiency. Adrenal Insuffiency, severe hypothyroidism, and

hypopituartism , enzyme deficiencies, RARE tumors, renal glycosuria( peeing

sugar), thin women ( not knowing them-BEING one of them-smile),etc

there is a PSEUDOhypoglycemia caused by autonomic stuff which MAY be many of our

cases as we know what the Lyme etc can do to the autonomic functions!!

OTHER DRUGS used for hypogly: metformin, anticholinergics ( a BIG no no for

many), calcium gluconate IV infusions,and Ive seen chromium supps but used under

Drs care due to dosing

ALL current literature ( even from Europe) says to resort to drugs ONLY if its

severe ( i.e. heart rhythm and other serious sx) and the gluc levels are VERY

low ( under 40) AND ONLY when diet cant fix it>

IF you find meds helping, great. BUT if you want to try other approaches and do

so carefully, why block your body's natural mechanisms??

as always be careful, be informes and be safe

Finette

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