Brief reportSuccessful use of acarbose to manage post-prandial glycaemia in two patients with type 1 diabetes on continuous subcutaneous insulin infusion
Introduction
Some patients with insulin-treated diabetes struggle to manage marked rises in post-prandial blood glucose, reporting that they are symptomatic with hyperglycaemia but that if they increase insulin doses to prevent these rises, they suffer from later hypoglycaemia. Post-prandial hyperglycaemia may also contribute significantly to elevated HbA1c values and may even be an independent risk factor for atherosclerosis [1], [2].
Here, we describe two patients with type 1 diabetes using CSII with persistently high post-prandial glucose refractory to alterations in insulin dose and delivery. We found that adjuvant treatment with acarbose markedly improved both post-prandial and overall glycaemic control suggesting that even for patients using CSII with advanced insulin delivery features, there may be merit in using acarbose to slow glucose absorption.
Section snippets
Case 1
Our first case is a 61-year-old lady (BMI 22) who was diagnosed with type 1 diabetes at the age of 13. Her HbA1c levels had generally been between 7.5 and 8% (58–64 mmol/mol) but she suffered from recurrent hypoglycaemia despite having attended a 5 day structured education programme (Dose Adjustment For Normal Eating—DAFNE) in 2006. Because of hypoglycaemia, she started CSII therapy (Medtronic 522, Medtronic, Northridge, CA, USA) in 2008, reporting an improvement in both hypoglycaemia and HbA1C
Discussion
Current strategies to manage post-prandial hyperglycaemia for those on CSII include delivering some or all bolus insulin 20 min prior to eating and/or adjusting basal insulin delivery to increase peri-prandially and then decrease 2–3 h after eating (sometimes termed a “super bolus”), reducing the glycaemic index of food and/or even restricting carbohydrate intake. Even with these strategies harnessing the advanced insulin delivery features of modern CSII, a significant number of patients, as our
Conclusions
Based on these 2 case reports, we suggest that when faced with post-prandial hyperglycaemia refractory to usual strategies with CSII insulin delivery, clinicians consider a trial of acarbose as an easy and parsimonious adjuvant to targeted insulin therapy.
Conflict of interest
There are no conflicts of interest.
References (7)
- et al.
International noninterventional study of acarbose treatment in patients with type 2 diabetes mellitus
Diabetes Res Clin Pract
(2011) - et al.
Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence
Diabetologia
(2001) - et al.
Postprandial glucose improves the risk prediction of cardiovascular death beyond the metabolic syndrome in the nondiabetic population
Diabetes Care
(2009)