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Insulin
6%
7/127
Glyburide
3%
4/127
Metformin
11%
14/127
Acarbose
75%
95/127
Exenatide
2%
3/127
Select Answer to see Preferred Response
The gut enzyme that is added to the solution is most likely alpha-glucosidase. The only agent that will inhibit the enzyme from breaking down sucrose into glucose and fructose thus showing a 0 mg/dL reading on the glucose meter is acarbose. Acarbose and miglitol are alpha-glucosidase inhibitors that prevent the breakdown of disaccharides and polysaccharides into monomers by alpha-glucosidase located along the intestinal brush border. This delays sugar hydrolysis resulting in a delayed glucose absorption. This is advantageous for patients with type II diabetes mellitus as it decreases postprandial hyperglycemia, thereby reducing insulin demand. Common side effects of these inhibitors are upset stomach, diarrhea, and flatulence. Servey reviews the evidence of alpha-glucosidase inhibitors ability to decrease the incidence of diabetes. She found that the incidence of both type 2 diabetes and cardiovascular problems were reduced. The evidence is limited as these studies were small and have yet to be replicated. Bischoff reviews the mechanism of action of alpha-glucosidase inhibitors. These agents function by a reversible, competitive, dose-dependent inhibition of alpha-glucosidase. These agents also have secondary effects such as decreasing triglyceride uptake into adipocytes, reducing hepatic lipogenesis, and lowering tryglyceride levels which all result from the decrease in post-prandial hyperglycermia and hyperinsulinemia. Illustration A depicts the mechanism of action of alpha-glucosidase inhibitors such as acarbose. Incorrect Answers: These medications do not inhibit alpha-glucosidase. Answer 1: Insulin acts on cells to uptake glucose into the cell. Answer 2: Glyburide mimics the action of glucose by closing potassium channels resulting in insulin release. Answer 3: Metformin acts to decrease gluconeogenesis, increase insulin sensitivity, increase glycoslysis, and decrease postprandial glucose levels. Answer 5: Exenatide is a GLP-1 agonist that aids in glucose-dependent insulin secretion.
4.6
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