U r really genuine sir Hypoglycemia is not so simple it's give you anxiety confusion and irritability and no anti depression or anti anxiety med work I am suffering from last 6years hypoglycemia make you worse
🎯 Key Takeaways for quick navigation: 01:04 *🩺 Acarbose: Mechanism of Action and Clinical Applications* - Acarbose inhibits enzymes involved in carbohydrate breakdown, preventing glucose absorption. - It primarily acts on postprandial glucose, making it useful in various types of diabetes. - Versatile usage includes type 2 diabetes, type 1 diabetes (in India), pancreatic diabetes, hypoglycemia in pregnancy, and hypoglycemic syndromes. 08:23 *📊 Glycemic Variability and Diabetes Management* - Glycemic variability, alongside fasting and postprandial glucose, is crucial in diabetes management. - It's assessed through metrics like standard deviation and coefficient of variation, with values above 36% indicating high variability. - Case studies illustrate the impact of glycemic variability on patient outcomes and the role of acarbose in reducing it. 14:25 *💡 Acarbose in Reducing Glycemic Variability: Case Study* - A case study demonstrates acarbose's efficacy in reducing glycemic variability and hypoglycemic episodes. - Combining acarbose with basal insulin shows significant flattening of the glucose curve, improving overall glycemic control. - The strategy of fixing fasting glucose first, followed by monitoring and adjustment, showcases effective diabetes management. 18:09 *📈 Clinical Cases: Acarbose in Various Diabetes Conditions* - Clinical cases highlight acarbose's effectiveness in type 2 diabetes management when combined with insulin and other medications. - Acarbose demonstrates utility in pancreatic diabetes, showing improved glycemic control in patients with chronic pancreatitis. - It can be utilized in hypoglycemia, including reactive hypoglycemia, expanding its applicability beyond conventional diabetes treatment. 21:43 *🩸 Treatment of Reactive Hypoglycemia* - Reactive hypoglycemia mainly occurs in early or pre-diabetic patients due to delayed and blunted first-phase insulin secretion. - Patients experience postprandial hypoglycemia due to a mismatch between glucose and insulin levels. - Acarbose can be effective in treating reactive hypoglycemia by delaying glucose absorption to match insulin secretion. 24:35 *🍽️ Mechanism of Action of Acarbose* - Acarbose delays glucose absorption, preventing postprandial hypoglycemia by blocking alpha-glucosidase enzymes. - It works in the oral cavity and intestine to inhibit carbohydrate breakdown, delaying glucose absorption. - Acarbose is versatile and can be used in various clinical situations, including type 2 diabetes, pancreatic diabetes, and pregnancy. 27:42 *🛑 Side Effects and Management* - Common side effects of acarbose include abdominal pain and gastrointestinal discomfort. - Side effects reduce over time as the gut microbiota adapt to the presence of unabsorbed carbohydrates. - Reducing carbohydrate intake can help minimize side effects associated with acarbose treatment. Made with HARPA AI
So overall take home messege is 1. Review fasting, pp and Hba1c 2. Fix fasting first 3. Switch to gliclazide if glimepiride is used 4. Monitor with cgm 5. Add acarbose if pp is persistently high.
Sir, Doubts: 1. Time- 18:20, Patient is not on an OHA. Patient clearly needs insulin. Couldn't we have used basal insulin alone to fix fasting and then, if PPBG is high , we could have added bolus insulin or acarbose. Why have you put him on metformin right from start? 2. Is there a thumb rule to find the dosages for OHAs ? E.g (Hypothetical) metformin 500 single tablet can reduce sugar level by 20-30 mg /dl. If we can find the starting dosage ,from there on we can titrate.
1. Metformin in first line treatment for all patients with type 2 diabetes unless contractions for the same 2. OAD titration is not perfect in that way. But have built the diabetology system on the same principle
Sir All you lectures are very informative. Please make a video on saroglitazar and its use in diabetics.Apart from treating dislipidemia is there any benifit on insulin resistance and glycemic control.
I’m really your fan and follow all your videos But here I respectfully disagree Acarbose have lots of GI side effects and our patients are never happy on acarbose
U r really genuine sir
Hypoglycemia is not so simple it's give you anxiety confusion and irritability and no anti depression or anti anxiety med work I am suffering from last 6years hypoglycemia make you worse
Excellent
Cannot thank you enough for all the valuable information given by you in your videos. You are an inspiration sir. Thank you.
Thank you
🎯 Key Takeaways for quick navigation:
01:04 *🩺 Acarbose: Mechanism of Action and Clinical Applications*
- Acarbose inhibits enzymes involved in carbohydrate breakdown, preventing glucose absorption.
- It primarily acts on postprandial glucose, making it useful in various types of diabetes.
- Versatile usage includes type 2 diabetes, type 1 diabetes (in India), pancreatic diabetes, hypoglycemia in pregnancy, and hypoglycemic syndromes.
08:23 *📊 Glycemic Variability and Diabetes Management*
- Glycemic variability, alongside fasting and postprandial glucose, is crucial in diabetes management.
- It's assessed through metrics like standard deviation and coefficient of variation, with values above 36% indicating high variability.
- Case studies illustrate the impact of glycemic variability on patient outcomes and the role of acarbose in reducing it.
14:25 *💡 Acarbose in Reducing Glycemic Variability: Case Study*
- A case study demonstrates acarbose's efficacy in reducing glycemic variability and hypoglycemic episodes.
- Combining acarbose with basal insulin shows significant flattening of the glucose curve, improving overall glycemic control.
- The strategy of fixing fasting glucose first, followed by monitoring and adjustment, showcases effective diabetes management.
18:09 *📈 Clinical Cases: Acarbose in Various Diabetes Conditions*
- Clinical cases highlight acarbose's effectiveness in type 2 diabetes management when combined with insulin and other medications.
- Acarbose demonstrates utility in pancreatic diabetes, showing improved glycemic control in patients with chronic pancreatitis.
- It can be utilized in hypoglycemia, including reactive hypoglycemia, expanding its applicability beyond conventional diabetes treatment.
21:43 *🩸 Treatment of Reactive Hypoglycemia*
- Reactive hypoglycemia mainly occurs in early or pre-diabetic patients due to delayed and blunted first-phase insulin secretion.
- Patients experience postprandial hypoglycemia due to a mismatch between glucose and insulin levels.
- Acarbose can be effective in treating reactive hypoglycemia by delaying glucose absorption to match insulin secretion.
24:35 *🍽️ Mechanism of Action of Acarbose*
- Acarbose delays glucose absorption, preventing postprandial hypoglycemia by blocking alpha-glucosidase enzymes.
- It works in the oral cavity and intestine to inhibit carbohydrate breakdown, delaying glucose absorption.
- Acarbose is versatile and can be used in various clinical situations, including type 2 diabetes, pancreatic diabetes, and pregnancy.
27:42 *🛑 Side Effects and Management*
- Common side effects of acarbose include abdominal pain and gastrointestinal discomfort.
- Side effects reduce over time as the gut microbiota adapt to the presence of unabsorbed carbohydrates.
- Reducing carbohydrate intake can help minimize side effects associated with acarbose treatment.
Made with HARPA AI
So overall take home messege is
1. Review fasting, pp and Hba1c
2. Fix fasting first
3. Switch to gliclazide if glimepiride is used
4. Monitor with cgm
5. Add acarbose if pp is persistently high.
Yes
Very good teaching,I have learnt valuable information.Thank you.
Thank you
Thank you very much sir for all of your educational videos.
I think it's also part of the psychologist problem. For example I'll be cured with a carbose . Hope my last 6years suffering ll be beneficial to other
Sir, Doubts:
1.
Time- 18:20,
Patient is not on an OHA. Patient clearly needs insulin.
Couldn't we have used basal insulin alone to fix fasting and then, if PPBG is high , we could have added bolus insulin or acarbose.
Why have you put him on metformin right from start?
2. Is there a thumb rule to find the dosages for OHAs ?
E.g (Hypothetical) metformin 500 single tablet can reduce sugar level by 20-30 mg /dl.
If we can find the starting dosage ,from there on we can titrate.
1. Metformin in first line treatment for all patients with type 2 diabetes unless contractions for the same
2. OAD titration is not perfect in that way. But have built the diabetology system on the same principle
@@EndocrinologyIndia Thanks Dr. Om and EndocrinologyIndia for the quick reply. Case studies are very helpful. Do keep posting them
Sir All you lectures are very informative.
Please make a video on saroglitazar and its use in diabetics.Apart from treating dislipidemia is there any benifit on insulin resistance and glycemic control.
Thank you
Yes it does improve glycemia as well
Sir, i have high fasting and postpandrial insulin levels. 40 uiuml and 300 uiuml. Facing non diabetic reactive hypoglycemia and my hb1ac 5.4 now
Difference between Gliclazide ER and MR when to prescribe it ?
As such there is little difference between them (also GLICLAZIDE XR) . To be given once a day before breakfast
Acarbose, doesn't have long term safety data, for its usage in DIP.
Are you comfortable with its usage in DIP
But I have hypoglycemia from my childhood my mother my both sisters same problem
By chewing a significant proportion might be absorbed in systemic circulation and little left to act on bruh boarder . what is your take on this issue
No that is not true
the problem is its unavailable and extremely expensive in my country otherwise i would prescribe it too
It's good add on drug , but patient compliance is low to moderate because of GI side effects
A obese Female PT already on Metformin 2g/day, how to start Acarbose in this case? HbA1c is 6.2
If the HbA1c already is 6.2 - acarbose is not required
But if you do need start 50
Mg TDS
@@EndocrinologyIndia can we lower the Metformin dosage in this case and start Acarbose?
@@nadirabbas8114no acarbose is an add on drug , metformin should be continued .
Lest c what happened next
I’m really your fan and follow all your videos
But here I respectfully disagree
Acarbose have lots of GI side effects and our patients are never happy on acarbose
Ultimatel sir 👌👌👌👌👌