Acarbose

INTRODUCTION

Indications

Management of type 2 diabetes in conjunction with dietary therapy; may be used with insulin or other hypoglycemic agents.

Action

Lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract. Delays and reduces glucose absorption. Therapeutic Effects: Lowering of blood glucose in diabetic patients, especially postprandial hyperglycemia.

Adverse Reactions/Side Effects

GI: abdominal pain, diarrhea, flatulence, ↑ transaminases.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia.

• Assess blood pressure periodically (see Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management, and should be reported to the physician.

Interventions

• Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

Patient/Client-Related Instruction

• Encourage patient to monitor blood glucose before and after exercise, and to adjust food intake to maintain normal glycemic levels.

• Emphasize the importance of adhering to nutritional guidelines, and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.

• Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruitlike breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst). Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

• Instruct patient to report troublesome GI problems, including severe or prolonged diarrhea, flatulence, and abdominal pain.

Pharmacokinetics

Absorption: <2% systemically absorbed; action is primarily local (in the GI tract).

Distribution: Unknown.

Metabolism and Excretion: Minimal amounts absorbed are excreted by the kidneys.

Half-life: 2 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Diabetic ketoacidosis; Cirrhosis; Serum creatinine >2 mg/dL; OB/Lactation/Pedi: Safety not established.

Use Cautiously in: Presence of fever, infection, trauma, stress (may cause hyperglycemia, requiring alternative therapy).

Interactions

Drug-Drug: Thiazide diuretics and loop diuretics, corticosteroids, phenothiazines, ...