A 58-year-old man with type 2 diabetes on metformin and acarbose takes his morning medications, then feels sweaty and confused. His capillary glucose is 48 mg/dL. His wife gives him three spoons of table sugar dissolved in water, but he does not improve. The correct next step is:

• A Give oral glucose gel instead of sucrose ✓
• B Repeat table sugar after 15 minutes
• C Administer intramuscular glucagon
• D Give oral fructose solution

Explanation

Acarbose competitively inhibits intestinal alpha-glucosidase enzymes, so disaccharides such as sucrose cannot be split into absorbable monosaccharides during an acute episode. Treatment of hypoglycaemia in a patient taking acarbose must use pure glucose (dextrose), which needs no enzymatic digestion. Fructose also fails because it does not raise blood glucose rapidly enough. Glucagon works by mobilising hepatic glycogen but its response is slower and oral glucose is the standard first step in a conscious patient.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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Written and medically reviewed by the StethoPrep medical team.