ACARBOSE

AN UNEXPECTED ALLY IN MANAGING REACTIVE HYPOGLYCEMIA IN PREGNANCY

Abstract

INTRODUCTION/BACKGROUND
Reactive hypoglycemia, or postprandial hypoglycemia, which can occur during pregnancy due to physiological changes such as altered insulin sensitivity and heightened metabolic needs, presents unique management considerations. Acarbose, an alpha-glucosidase inhibitor, offers a potential therapeutic strategy by slowing the digestion and absorption of carbohydrates, thereby helping to regulate postprandial glucose levels and prevent hypoglycemic episodes in pregnant women.

CASE
We present the case of a 25-year-old pregnant female diagnosed with overt diabetes mellitus at 10 weeks of gestation via oral glucose tolerance test (OGTT). Initially she was started with insulin and metformin, however despite dietary adjustments and titration of medications, she experienced recurrent hypoglycemic episodes. These episodes occurred 1-2 hours after meals and were refractory to conventional management. Acarbose was then initiated at 28 weeks of gestation. During her third trimester, she required basal bolus insulin regimen with adjustment of acarbose dose. Throughout the pregnancy, the patient's blood glucose and fetal well-being were closely monitored and her glucose levels remained well-controlled. She delivered at 37 weeks of gestation, and both mother and baby were discharged in good health.

CONCLUSION
Acarbose may be a valuable addition to the treatment plan for pregnant women experiencing postprandial hypoglycemia, particularly when conventional treatments such as insulin therapy and dietary modification are inadequate. Although further research is needed to establish the safety and efficacy of acarbose in pregnancy, this case suggests that acarbose could be an effective and safe option for managing postprandial hypoglycemia in diabetic pregnancies.