The clinical challenge
Hypoglycemia management rules suggest the use of sugar, honey, candy, and fruit juice, among other foodstuffs, for the resolution of episodes of low glucose. This strategy, however, assumes that the carbohydrate being ingested will be absorbed and digested by the gastrointestinal tract, and then assimilated by the body.
Alpha-glucosidase inhibitors (AGIs) are oral glucose-lowering drugs which act by inhibiting the digestion of sugars and starch, thus reducing the levels of glucose. AGIs are safe drugs to use, and rarely cause hypoglycemia. It may be possible, however, that a patient on combination therapy (including AGIs) develops hypoglycemia due to concomitant treatment such insulin or sulfonylureas. In such a case, most traditional solutions for hypoglycemia reversal, such as table sugar (sucrose), fruit juice (fructose), and other complex carbohydrates, will not be effective. AGIs will prevent these compounds from breaking down to glucose, and will impair their efficacy.
In case glucose is not available, honey or sugar can be administered sublingually or buccally, to achieve absorption through non-parenteral routes.
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A pragmatic solution
The treatment for hypoglycemia in persons being treated with AGIs, therefore, is glucose. Glucose powder, tablets or drinks can be used to normalize glycemia, using the 15–15 rule (15 grams of glucose, followed by a check after 15 minutes). In case glucose is not available, honey or sugar can be administered sublingually or buccally, to achieve absorption through non-parenteral routes. If these means do not work, a parenteral glucose infusion may be required.
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