Glyset (miglitol) is an alpha-glucosidase inhibitor designed to manage postprandial hyperglycemia in adults with type 2 diabetes mellitus. By delaying carbohydrate digestion and absorption in the small intestine, it moderates the post-meal rise in blood glucose. It is typically prescribed as an adjunct to diet and exercise, and may be used alone or in combination with other antidiabetic agents such as sulfonylureas or metformin. Glyset offers a targeted mechanism of action with a favorable safety profile, making it a valuable option in comprehensive diabetes management strategies.

Features

• Active ingredient: Miglitol 25mg, 50mg, or 100mg tablets
• Mechanism: Alpha-glucosidase inhibitor
• Delays digestion of complex carbohydrates and disaccharides
• Reduces postprandial glucose and insulin levels
• Minimal systemic absorption; acts locally in the gastrointestinal tract
• Administered orally at the start of each main meal

Benefits

• Effectively lowers postprandial blood glucose spikes
• Helps achieve and maintain target HbA1c levels
• Reduces glycemic variability throughout the day
• May contribute to weight neutrality or modest weight management
• Low risk of hypoglycemia when used as monotherapy
• Compatible with other oral antidiabetic regimens

Common use

Glyset is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. It is particularly useful in patients who experience significant postprandial hyperglycemia. It may be used as monotherapy or in combination with a sulfonylurea, metformin, or insulin when glycemic targets are not achieved with single-agent therapy. Clinical use is supported by evidence demonstrating reductions in both fasting and postprandial glucose levels.

Dosage and direction

The recommended starting dosage is 25mg taken orally three times daily at the beginning (with the first bite) of each main meal. The dosage may be gradually increased to 50mg three times daily after 4–8 weeks based on tolerability and glycemic response. For patients requiring further glycemic control, the dosage may be increased to 100mg three times daily. Dosage adjustments should be made under medical supervision, particularly in elderly patients or those with renal impairment. Maximum recommended dosage is 100mg three times daily.

Precautions

• Gastrointestinal symptoms (flatulence, diarrhea, abdominal pain) are common initially but often diminish with continued use
• Not recommended for patients with significant renal impairment (creatinine clearance <25 mL/min)
• Use with caution in patients with inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction
• Monitor liver function periodically during long-term therapy
• May reduce serum iron levels; consider monitoring hematologic parameters in susceptible patients
• Not intended for use in type 1 diabetes or for the treatment of diabetic ketoacidosis

Contraindications

• Hypersensitivity to miglitol or any component of the formulation
• Diabetic ketoacidosis
• Inflammatory bowel disease
• Colonic ulceration
• Partial intestinal obstruction or predisposition to intestinal obstruction
• Chronic intestinal diseases associated with marked disorders of digestion or absorption
• Conditions that may deteriorate as a result of increased gas formation in the intestine

Possible side effects

Most common adverse reactions are related to the mechanism of action and affect the gastrointestinal system:

• Flatulence (41.5%)
• Diarrhea (28.7%)
• Abdominal pain (11.7%)
• Nausea (9.1%)
• Dyspepsia (5.7%)
• Rash (4.1%)
• Headache (3.7%)
• These symptoms are usually dose-related and tend to decrease in frequency and intensity with continued treatment

Drug interaction

• May reduce bioavailability of digoxin, ranitidine, and propranolol; administer these drugs at least 2 hours before or after Glyset
• Charcoal-containing preparations may reduce miglitol’s effectiveness
• Digestive enzymes (pancreatin, amylase) may reduce Glyset’s efficacy
• Additive effects with other hypoglycemic agents may increase risk of hypoglycemia
• Thiazide diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid may reduce hypoglycemic effect

Missed dose

If a dose is missed, skip it and take the next dose at the regular time. Do not double the dose to make up for a missed one. Taking extra tablets may increase gastrointestinal side effects without providing additional glycemic benefit.

Overdose

Overdose may result in transient increases in flatulence, diarrhea, and abdominal discomfort. Hypoglycemia has not been reported with miglitol overdose alone. However, if Glyset is taken with sulfonylureas or insulin, hypoglycemia may occur. In case of suspected overdose, provide supportive care and monitor blood glucose levels. Since miglitol is not significantly absorbed systemically, dialysis is not expected to be beneficial.

Storage

Store at controlled room temperature 20°C to 25°C (68°F to 77°F). Excursions permitted between 15°C and 30°C (59°F and 86°F). Keep container tightly closed and protect from moisture. Keep out of reach of children. Discard any unused medication after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Glyset should be used only under the supervision of a qualified healthcare provider. Dosage and administration should be individualized based on the patient’s medical condition, response to therapy, and concomitant medications. Patients should not adjust their dosage without consulting their healthcare provider. The full prescribing information should be consulted before initiating therapy.

Reviews

Clinical studies have demonstrated Glyset’s efficacy in reducing HbA1c by 0.4% to 1.0% when used as monotherapy and by additional 0.5% to 0.8% when combined with sulfonylureas. In a 1-year study, 100mg three times daily produced mean reductions in HbA1c of 0.9% from baseline. Postprandial glucose levels were reduced by 40-50 mg/dL compared to placebo. Most gastrointestinal adverse events decreased substantially after the first 12 weeks of therapy. Long-term extension studies have shown maintained efficacy with good tolerability profile over 3 years of treatment.