A type 2 diabetic patient taking acarbose with each meal starts basal insulin and later becomes hypoglycemic. The nurse gives him three teaspoons of table sugar dissolved in water, but his glucose fails to rise. The correct immediate treatment is:

• A Give oral glucose tablets or intravenous dextrose ✓
• B Repeat the table sugar in double quantity
• C Give fruit juice sweetened with honey
• D Give a starch-rich snack such as bread

Explanation

Acarbose competitively inhibits intestinal alpha-glucosidases, blocking the breakdown of disaccharides and complex carbohydrates into absorbable monosaccharides. Sucrose (table sugar) and starch cannot be hydrolyzed while the drug acts, so they fail to correct hypoglycemia. Only free glucose (dextrose tablets) or parenteral dextrose works. Honey and juice contain disaccharides and fructose, which are also ineffective under acarbose blockade.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.