Which oral antidiabetic do I use the most?
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- čas přidán 21. 08. 2024
- Dr. Om J Lakhani talks about Acarbose . It is one of the most versatile oral antidiabetic
01:04 🩺 Acarbose: Mechanism of Action and Clinical Applications
Acarbose inhibits enzymes involved in carbohydrate breakdown, preventing glucose absorption.
It primarily acts on postprandial glucose, making it useful in various types of diabetes.
Versatile usage includes type 2 diabetes, type 1 diabetes (in India), pancreatic diabetes, hypoglycemia in pregnancy, and hypoglycemic syndromes.
08:23 📊 Glycemic Variability and Diabetes Management
Glycemic variability, alongside fasting and postprandial glucose, is crucial in diabetes management.
It's assessed through metrics like standard deviation and coefficient of variation, with values above 36% indicating high variability.
Case studies illustrate the impact of glycemic variability on patient outcomes and the role of acarbose in reducing it.
14:25 💡 Acarbose in Reducing Glycemic Variability: Case Study
A case study demonstrates acarbose's efficacy in reducing glycemic variability and hypoglycemic episodes.
Combining acarbose with basal insulin shows significant flattening of the glucose curve, improving overall glycemic control.
The strategy of fixing fasting glucose first, followed by monitoring and adjustment, showcases effective diabetes management.
18:09 📈 Clinical Cases: Acarbose in Various Diabetes Conditions
Clinical cases highlight acarbose's effectiveness in type 2 diabetes management when combined with insulin and other medications.
Acarbose demonstrates utility in pancreatic diabetes, showing improved glycemic control in patients with chronic pancreatitis.
It can be utilized in hypoglycemia, including reactive hypoglycemia, expanding its applicability beyond conventional diabetes treatment.
21:43 🩸 Treatment of Reactive Hypoglycemia
Reactive hypoglycemia mainly occurs in early or pre-diabetic patients due to delayed and blunted first-phase insulin secretion.
Patients experience postprandial hypoglycemia due to a mismatch between glucose and insulin levels.
Acarbose can be effective in treating reactive hypoglycemia by delaying glucose absorption to match insulin secretion.
24:35 🍽️ Mechanism of Action of Acarbose in Post-prandial hypoglycemia
Acarbose delays glucose absorption, preventing postprandial hypoglycemia by blocking alpha-glucosidase enzymes.
It works in the oral cavity and intestine to inhibit carbohydrate breakdown, delaying glucose absorption.
Acarbose is versatile and can be used in various clinical situations, including type 2 diabetes, pancreatic diabetes, and pregnancy.
27:42 🛑 Side Effects and Management
Common side effects of acarbose include abdominal pain and gastrointestinal discomfort.
Side effects reduce over time as the gut microbiota adapt to the presence of unabsorbed carbohydrates.
Reducing carbohydrate intake can help minimize side effects associated with acarbose treatment.
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🎯 Key Takeaways for quick navigation:
01:04 *🩺 Acarbose: Mechanism of Action and Clinical Applications*
- Acarbose inhibits enzymes involved in carbohydrate breakdown, preventing glucose absorption.
- It primarily acts on postprandial glucose, making it useful in various types of diabetes.
- Versatile usage includes type 2 diabetes, type 1 diabetes (in India), pancreatic diabetes, hypoglycemia in pregnancy, and hypoglycemic syndromes.
08:23 *📊 Glycemic Variability and Diabetes Management*
- Glycemic variability, alongside fasting and postprandial glucose, is crucial in diabetes management.
- It's assessed through metrics like standard deviation and coefficient of variation, with values above 36% indicating high variability.
- Case studies illustrate the impact of glycemic variability on patient outcomes and the role of acarbose in reducing it.
14:25 *💡 Acarbose in Reducing Glycemic Variability: Case Study*
- A case study demonstrates acarbose's efficacy in reducing glycemic variability and hypoglycemic episodes.
- Combining acarbose with basal insulin shows significant flattening of the glucose curve, improving overall glycemic control.
- The strategy of fixing fasting glucose first, followed by monitoring and adjustment, showcases effective diabetes management.
18:09 *📈 Clinical Cases: Acarbose in Various Diabetes Conditions*
- Clinical cases highlight acarbose's effectiveness in type 2 diabetes management when combined with insulin and other medications.
- Acarbose demonstrates utility in pancreatic diabetes, showing improved glycemic control in patients with chronic pancreatitis.
- It can be utilized in hypoglycemia, including reactive hypoglycemia, expanding its applicability beyond conventional diabetes treatment.
21:43 *🩸 Treatment of Reactive Hypoglycemia*
- Reactive hypoglycemia mainly occurs in early or pre-diabetic patients due to delayed and blunted first-phase insulin secretion.
- Patients experience postprandial hypoglycemia due to a mismatch between glucose and insulin levels.
- Acarbose can be effective in treating reactive hypoglycemia by delaying glucose absorption to match insulin secretion.
24:35 *🍽️ Mechanism of Action of Acarbose*
- Acarbose delays glucose absorption, preventing postprandial hypoglycemia by blocking alpha-glucosidase enzymes.
- It works in the oral cavity and intestine to inhibit carbohydrate breakdown, delaying glucose absorption.
- Acarbose is versatile and can be used in various clinical situations, including type 2 diabetes, pancreatic diabetes, and pregnancy.
27:42 *🛑 Side Effects and Management*
- Common side effects of acarbose include abdominal pain and gastrointestinal discomfort.
- Side effects reduce over time as the gut microbiota adapt to the presence of unabsorbed carbohydrates.
- Reducing carbohydrate intake can help minimize side effects associated with acarbose treatment.
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Very good teaching,I have learnt valuable information.Thank you.
Thank you
So overall take home messege is
1. Review fasting, pp and Hba1c
2. Fix fasting first
3. Switch to gliclazide if glimepiride is used
4. Monitor with cgm
5. Add acarbose if pp is persistently high.
Yes
Cannot thank you enough for all the valuable information given by you in your videos. You are an inspiration sir. Thank you.
Thank you
Sir All you lectures are very informative.
Please make a video on saroglitazar and its use in diabetics.Apart from treating dislipidemia is there any benifit on insulin resistance and glycemic control.
Thank you
Yes it does improve glycemia as well
Thank you very much sir for all of your educational videos.
Acarbose, doesn't have long term safety data, for its usage in DIP.
Are you comfortable with its usage in DIP
By chewing a significant proportion might be absorbed in systemic circulation and little left to act on bruh boarder . what is your take on this issue
No that is not true
A obese Female PT already on Metformin 2g/day, how to start Acarbose in this case? HbA1c is 6.2
If the HbA1c already is 6.2 - acarbose is not required
But if you do need start 50
Mg TDS
@@EndocrinologyIndia can we lower the Metformin dosage in this case and start Acarbose?
@@nadirabbas8114no acarbose is an add on drug , metformin should be continued .
the problem is its unavailable and extremely expensive in my country otherwise i would prescribe it too
It's good add on drug , but patient compliance is low to moderate because of GI side effects
I’m really your fan and follow all your videos
But here I respectfully disagree
Acarbose have lots of GI side effects and our patients are never happy on acarbose
Ultimatel sir 👌👌👌👌👌