FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PRECOSE WON'T CAUSE READER'S BLOOD SUGAR TO DROP TOO LOW

Question: I'm an insulin dependent diabetic. My doctor recently started me on a new medicine called Precose. It has reduced the amount of insulin I need, but I'm concerned about it causing low blood sugar. Is Precose a safe medicine?

Answer: Precose is the brand name of a new drug with the generic name acarbose. It helps a diabetic individual control blood sugar by delaying the absorption of sugar from the digestive tract. But before I say more about it, I want to review some background information on diabetes for you and my other readers.

Diabetes is a complicated illness that affects every part of the body. The easiest change for doctors to measure is the increase in blood sugar that is the single most characteristic feature of this disease. Despite this overabundance blood sugar - or "glucose" in doctor jargon - the body's cells have difficulty using it to fuel their metabolic activities.

Those with high blood sugar levels are labeled with the diagnosis "diabetes," but this condition can come about from two very different causes. Some individuals have inadequate levels of insulin, the hormone necessary for cells to use this glucose effectively, because the insulin producing cells of the pancreas become damaged. These individuals require insulin shots to replace the insulin their bodies can't make. The term you used in your letter, insulin dependent, describes you and individuals in this situation.

The individuals with the most common form of diabetes make sufficient amounts of insulin, but their body's cells can't use it properly. The body responds by raising the glucose level in the blood to try and make it more available to the cells, and this causes the high sugar that establishes the diagnosis of diabetes. This prevalent form of diabetes is most common later in life, and a diet high in sweets and/or obesity can contribute to it.

Regardless of the cause, treatment for diabetes involves eating a diet that is very low in sugar. Individuals with the second form of diabetes - often referred to as "adult onset," "type II," or "non-insulin dependent diabetes" - may achieve adequate control of their disease by diet alone. However, medication to help the cells use the naturally produced insulin more efficiently or to increase the level of insulin produced by the pancreas are often prescribed.

The medicine, Precose, delays the absorption of sugar from the digestive tract. This minimizes the amount of sugar that is available from the food you eat and can be helpful for individuals with either type of diabetes. It won't cause low blood sugar as medicines that increase the production of insulin can. The greatest problem with this new drug is the stomach upset and gas that are common side effects. A few people find them sufficiently severe that they stop taking the medicine. Since you haven't complained of stomach upset, I'd suggest that you continue with Precose, just as your doctor prescribed. It won't cause your blood sugar to drop too low, it just helps it stay in the normal range.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.