Acarbose is an a-glucosidase inhibitor which reduces digestion of complex carbohydrates and slows their absorption from the gut; in high doses it may cause actual malabsorption. Acarbose reduces glycaemia after meals, and may improve overall glycaemic control. The usual dose is 50-300 mg daily. Adverse effects are mainly flatulence and diarrhoea, which lead to a high discontinuation rate. The drug may be combined with a sulphonylurea.
Dietary fibre and diabetes. The addition of gel-forming (soluble) but unabsorbable fibre (guar gum, a hydrocolloidal polysaccharide of galactose and mannose from seeds of the 'cluster bean') to the diet of diabetics reduces carbohydrate absorption and flattens the postprandial blood glucose curve. Reduced need for insulin and oral agents are reported, but adequate amounts (taken with lots of water) are unpleasant (flatulence) and patient compliance is therefore poor.
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