DrVirgo
Forum Hero
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ok, one more question. 
A 63 year old white man comes to the office complaining of persistently elevated fasting blood glucose levels for the past 3 days. His recorded glucose at home exceeded 300 mg/dL during this period. Two years ago, he was diagnosed with type 2 DM, which had been "effectively controlled by diet and acarbose". He took twice the usual dose of acarbose yesterday and four times the usual dose today in attempt to control the elevated blood glucose. Random blood glucose measurement in the office reveals a level of 310 mg/dl. What is the most probable effect of the excess medication taken by this patient?
A. Delayed hypoglycemia
B. Liver damage
C. Edema
D. Lactic Acidosis
E. Increased carbohydrate loss in the stool
My question is: WHY is his glucose so HIGH despite the HIGH dose of acarbose?
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| sprint123
Forum Guru
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Impairing the digestion of carbohydrates by inhibiting alpha-glucosidase IN EXCESS can cause significant LIVER damage....
No idea on why the blood sugar is increased.....
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| yasmeen
Forum Guru
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liver damage
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| msrdr007
Forum Newbie
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it is because agarbose acts by only reducing the glucose absorption from the gut and has no effect directly on the blood glucose levels...
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| msrdr007
Forum Newbie
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by the way answer is E. loss of carbohydrate in stool.....
another intresting thing to add...if patient on acarbose develops hypoglycemia u need to give him monosaccharides like glucose, just as it is the case with other hypoglycemic drugs.
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| dr in trouble
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The answer is E,
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| DrVirgo
Forum Hero
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Yes, the answer is E... that's just the mechanism of acarbose.
But this question makes no sense to me... why was he controlled for two years and then all of a sudden for the last 2 days has an INCREASED glucose level? Especially when he took TOO MUCH acarbose. Even if the acarbose only blocks the GI absorption of glucose, it should control it somewhat, NOT increase it! correct?
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| dr in trouble
Forum Guru
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Sprint 123-------UW says that Acarbose does not cause liver damage
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| DrVirgo
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anyone?
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| Justice
Forum Fanatic
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DrVirgo wrote:
anyone?
I guess it is an intentional "mystypo" to make the story rich...
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| elitoki
Forum Guru
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I think by deacreasing GI absoption, it could cause hypoglycemia and activate gluconeogenesis pathway producing hyperglycemia. Posteriorly,the glycemia is getting worse each time that increase acarbose dosis.
I could be wrong but it sounds more logical for me!
let me know if I'm wrong. 
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| doc_clotaire
Forum Guru
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I agree with Justice BIG TIME
Remember guys , we are just studying to answer stupid questions who most likely don ' t make any sense in real life . This exam ain' t real man .
Just stick to whatever they say and lurn them all just get your ECFMG CERTIFICATION .. that's it ....
It 's just my 2 cents ..............
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| radonc
Forum Senior
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Why does his sugars play up now? Well, most patients have worsening of their diabetes over time. Most type 2 diabetics can control their sugar levels with diet and exercise initially, but they will later need diabetic medications to bring down their sugars. It's just the natural progression of the disease. Some type 2 diabetics will end up requiring insulin.
Like in this question, the man's sugars were initially well-controlled with acarbose and diet. But that was two years ago, and now his diabetes have progressed. He will need other anti-diabetic medications, such as sulphonylurea.
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| wywywy2006
Forum Elite
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I want to add one point.
The blood glucose level after he took much more acarbose is not significantly different from the level before he increased his dose. The DM progressed already. Acarbose did not affect his glucose level at all.
Don't get wrong impression that high glucose level is due to the increased dose of acarbose.
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