Miglitol

 Action Inhibits intestinal enzymes that digest carbohydrates, thereby reducing carbohydrate digestion after meals, which lowers postprandial glucose elevation in diabetics.

 Indications Patients with NIDDM who have failed dietary therapy. May be used alone or in combination with sulfonylureas.

 Contraindications Diabetic ketoacidosis; inflammatory bowel disease; colonic ulceration; ntestinal disorders of digestion or absorption; partial or predisposition to intestinal obstruction; conditions that may deteriorate as a result of increased intestinal gas production.

 Route/Dosage

ADULTS: PO 25 mg tid at the start of each meal. After 4–8 weeks can increase to 50 mg/dose for 3 months. If glycosylated hemoglobin level not acceptable after 3 months can increase at 100 mg tid (maximum dose).

 Interactions

Intestinal absorbents (eg, charcoal), digestive enzymes: May lower efficacy of miglitol. Drugs that produce hyperglycemia (eg, corticosteroids, diuretics, thyroid preparations): May lead to loss of glucose control. Ranitidine: Reduced ranitidine bioavailability. Propranolol: Reduced propranolol bioavailability.

 Lab Test Interferences Transient decreases in serum iron that are not associated with hemoglobin reduction or other changes in hematologic indices.

 Adverse Reactions

DERM: Rash. GI: Abdominal pain; diarrhea; flatulence.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Hypoglycemia: Miglitol does not produce hypoglycemia; however, hypoglycemia may develop if used together with sulfonylureas. Use glucose (dextrose) and not cane sugar table sugar) or fruits/fruit juices to treat hypoglycemia. Loss of blood glucose control: Certain medical conditions (eg, surgery, fever, infection, or trauma) nd drugs (eg, diuretics, corticosteroids, oral contraceptives) affect glucose control. In these situations, it may be necessary to adjust the dose of miglitol and other antidiabetic drugs. Renal impairment: Miglitol not recommended if serum creatinine > 2.0 mg/dl.

 Administration/Storage

• The medication should be taken with the first bite of each meal.
• Store at room temperature in a tightly closed container, protected from moisture.

 Assessment/Interventions

• Therapy is monitored by 1–hour postprandial blood glucose tests and periodic glycosylated hemoglobin determinations.
• If hypoglycemia develops, use oral or parenteral glucose dextrose) to increase blood glucose instead of sucrose (cane or table sugar) r fruits/fruit juice, since the metabolism of sucrose is inhibited by miglitol.
• Renal function should be assessed prior to starting medication.
• Monitor patient for GI side effects. Notify physician if intolerable.
• Monitor patient for hypoglycemia if this medication is combined with sulfonylurea.

 Patient/Family Education

• Advise patient to take the drug with the first bite of each meal. If necessary, it may be taken during the meal if not taken with the first bite. Do not take after the meal is complete or if skipping a meal.
• Advise patient not to change the dose or dosing interval or discontinue the drug without consulting with their physician.
• Encourage patient to continue to adhere to a regular exercise program and follow their diabetic meal plan.
• Counsel patient on proper monitoring of blood glucose.
• Advise women of childbearing age that this medication should not be used during pregnancy. Insulin is the preferred agent to control blood glucose.
• Advise patient family that “cane sugar” (sucrose or table sugar) or fruits or fruit juices should not be used to treat hypoglycemic reactions. Glucose (dextrose) or glucagon are necessary to increase blood sugar.
• Advise patient that GI side effects (gas, diarrhea, or abdominal discomfort) usually occur during the first few weeks of therapy but generally go away. Advise patient to inform healthcare provider if these effects persist or become intolerable.