The alpha glucosidase inhibitor acarbose is used in the management of type 2 (non-insulin dependent) diabetes, and works by delaying thedigestion and absorption of glucose and starch. It may be used alone or in combination with other antidiabetic medication.

Dosage regimen

* Acarbose is taken three times a day.

Patient's knowledge of the medicine's use

* Alpha glucosidase inhibitors may be used alone or with other antidiabetic drugs.

Is the medicine working?

* Is the patient aware of the need to perform regular blood glucose checks, and what the normal range is?

* If the patient has been taking medication correctly but still has high blood sugar levels, refer to his or her GP.

Side-effects

* The main side effect of acarbose is flatulence, though this usually diminishes with time. Acarbose can also cause soft stools, diarrhoea and, rarely, liver problems.

Monitoring

* Ensure the patient knows the signs of hypoglycaemia, which include sweating, blurred vision, paleness, confusion, tingling lips, mood changes, trembling and anxiety. Advise patients to eat glucose and not sugar in an attack.

* Liver function should be monitored.

Lifestyle

* Diet is an important aspect in the control of diabetes. Patients should be encouraged to eat more fruit, vegetables, fish, and fibre. They should reduce their consumption of sugar, salt, fat and alcohol.

* Patient should be encouraged to lose weight if needed.

* Patients who smoke should be given advice on smoking cessation.

* Encourage patients to be more physically active. Ideally patients should aim to exercise for 30 minutes at least five times a week.

* Patients should be advised to see a chiropodist and optician regularly, to ensure signs of peripheral or retinal neuropathy are picked up early.

* Patients with diabetes should be advised to have an influenza vaccination each year and a one-off pneumococcal vaccine.

* Patients with diabetes are at higher than normal risk of heart disease, stroke and renal disease, and may be on medication such a statin, aspirin, and antihypertensives. Emphasise the need to comply with these medicines.

Uzma Chaudhry, relief pharmacist, Lloydspharmacy, Oxfordshire / AF

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