Acarbose — Frequently Asked Questions

By slowing carbohydrate digestion rather than by acting on insulin. Dietary starch and sucrose must be broken down to monosaccharides by alpha-glucosidase enzymes in the intestinal brush border before they can be absorbed. Acarbose competitively inhibits those enzymes, so absorption is spread over a longer stretch of intestine and a longer period, blunting the post-meal glucose peak.

Because it does not stimulate insulin release or increase insulin sensitivity. It only slows the rate at which glucose enters the bloodstream from a meal, so it cannot drive blood glucose below normal the way an insulin secretagogue can. Hypoglycaemia can still occur when it is combined with insulin or a sulfonylurea.

Because of its mechanism. Carbohydrate that is not digested in the small intestine passes into the colon, where gut bacteria ferment it and produce gas. That is a direct and predictable consequence of slowing digestion, and it is dose-limiting for some patients. The effect often diminishes as the gut flora adapt over several weeks.

It is a pharmaceutical active ingredient, so it is supplied to pharmacopoeial specification on assay, related substances, water, residual solvents, microbiology and heavy metals, with the regulatory documentation the intended market requires. The manufacturing site, its regulatory status and the intended market should be established at enquiry.