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What are alpha-glucosidase inhibitors?
Alpha-glucosidase inhibitors or AGIs are starch blockers. They are oral medications for type 2 diabetes that slow down the absorption of carbohydrates from your diet. Alpha-glucosidase inhibitors include the drugs Acarbose and Miglitol. However, Acarbose, also known by its commercial name Glucobay, is the medication used in the UK.
How do alpha-glucosidase inhibitors work?
Alpha-glucosidase inhibitors work by reducing the absorption of sugars and starches from the food you eat. They block the enzymes in the small bowel that break down carbohydrates, slowing down their digestion. As a result of their action, glucose energy will be absorbed more slowly into your bloodstream.
When you take alpha-glucosidase inhibitors before a meal, your blood glucose levels will rise more gradually after eating. You are less likely to have blood sugar spikes after a meal or snack.
When you live with type 2 diabetes, your doctor is likely to prescribe Acarbose if lifestyle changes like diet and physical activity haven’t controlled your blood sugar levels. They may prescribe it alone or together with another medication such as sulphonylurea.
Alpha-glucosidase inhibitors are particularly useful if you have hypers and problems controlling your blood glucose after eating.
How do you take alpha-glucosidase inhibitors?
Acarbose is a tablet that you should take orally. You should swallow the tablet with a little water just before your meal or chew it with your first mouthful of food.
Advantages of alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors (AGIs) can help you control your type 2 diabetes. The advantages include:
- AGIs allow glucose levels to rise more gradually after food
- AGIs inhibitors reduce your blood sugars after a meal and prevent spikes in your blood glucose after eating
- Alpha-glucosidase inhibitors cause a small but significant improvement in your blood glucose control
- AGIs help to lower HbA1c, particularly when used in combination with other diabetes medications
- Alpha-glucosidase inhibitors increase levels of GLP-1 after eating. GLP-1 or glucagon-like peptide-1 (GLP-1) is an incretin hormone that slows digestion, decreases appetite and helps you feel fuller more quickly during a meal. As a result, Acarbose medication can support weight loss
Side effects of alpha-glucosidase inhibitors
Acarbose can disturb your gastrointestinal system, especially if you eat a meal with lots of starchy carbohydrates. Reducing the carbs in your food and gradually increasing the dose of your alpha-glucosidase inhibitor can reduce problems and help you tolerate the medication better. The side effects of alpha-glucosidase inhibitors include:
- Abdominal pain and cramps
- Flatulence (wind)
- Diarrhoea and GI disturbance
- Rarely Acarbose can cause more serious complications, including liver problems, oedema and low platelets
Alpha-glucosidase inhibitors and weight loss
Obesity is strongly linked with type 2 diabetes, with some people able to put their diabetes into remission by losing significant amounts of weight. However, weight loss can be a challenge. When you live with diabetes, losing weight can be even more difficult because insulin therapy and some oral diabetes medications (such as sulphonylureas and thiazolidinediones) are associated with weight gain.
Some research studies indicate that for people with type 2 diabetes on weight-maintaining diets, Acarbose therapy results in a small weight loss. Surveys in a real-world setting also show that acarbose treatment reduces body weight independent of the level of blood glucose control.
Experts suggest that the weight loss may be linked to several factors:
- Taking Acarbose regularly can reduce the need for insulin and other medications that can cause weight gain
- Alpha-glucosidase inhibitors boost levels of glucagon-like peptide-1 (GLP-1) after a meal. This slows down digestion, reduces your appetite and makes you feel satisfied sooner after eating
- You may burn more energy because of increased fermentation in the large bowel
- People taking Acarbose may make dietary changes and reduce carbohydrate intake to reduce side effects
Natural alpha-glucosidase inhibitors
- Healers have harnessed the power of traditional remedies, medicinal plants and herbs throughout history. Several natural products act to inhibit alpha-glucosidase. Extracts from these medicinal plants could potentially be used to help treat type 2 diabetes. The extracts work in the same way as alpha-glucosidase inhibitor drugs to prevent the fast breakdown of starches and sugars and consequently help control the blood sugar level.
A range of plants and vegetables is being investigated for alpha-glucosidase inhibitory activity, including Grapeseed and green tea extracts, mango leaves, jackfruit peel, extracts from pepper, tomato and aubergine many more. However, it’s essential to be aware that the quality, dosage, and effects of extracts and supplements will be less controlled and regulated than licenced medications.
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Carol Willis - Diabetes Clinic Facilitator
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