Glyset (miglitol) is an alpha-glucosidase inhibitor oral medication specifically designed to manage blood glucose levels in adults with type 2 diabetes mellitus. By targeting carbohydrate digestion in the small intestine, it delays the breakdown of complex sugars and sucrose, resulting in a moderated and more physiological postprandial glucose rise. This mechanism offers a complementary approach to diabetes management, particularly useful when diet and exercise alone are insufficient and when a targeted post-meal strategy is warranted. It is often prescribed as monotherapy or in combination with other antidiabetic agents, such as sulfonylureas, to provide a multifaceted glycemic control strategy. Glyset represents a focused therapeutic option for clinicians seeking to address the specific challenge of postprandial hyperglycemia without inducing systemic hypoglycemia through insulin secretion.

Features

• Active ingredient: Miglitol 25mg or 50mg tablets
• Pharmacologic class: Alpha-glucosidase inhibitor
• Delays the digestion of ingested carbohydrates
• Reduces postprandial blood glucose elevations
• Minimal systemic absorption; acts locally within the gastrointestinal tract
• Not metabolized; excreted unchanged by the kidneys

Benefits

• Provides targeted control of postprandial hyperglycemia, a key contributor to overall glycemic exposure (HbA1c)
• Lowers the risk of late diabetes complications by improving overall glycemic stability
• Does not cause hypoglycemia when used as monotherapy, enhancing patient safety
• May support modest weight stabilization or loss as part of a comprehensive dietary plan
• Compatible with other glucose-lowering agents for individualized treatment regimens
• Reduces glucose spikes after meals, helping patients avoid symptoms of hyperglycemia

Common use

Glyset is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is particularly effective in patients who experience significant postprandial glucose excursions. It may be used as monotherapy or in combination with a sulfonylurea when dual-mechanism therapy is required. Glyset is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis.

Dosage and direction

The recommended starting dosage of Glyset is 25 mg taken orally three times daily at the start (with the first bite) of each main meal. The dosage may be increased after 4 to 8 weeks to 50 mg three times daily based on tolerability and 1-hour postprandial glucose levels or HbA1c. A further increase to 100 mg three times daily may be considered for patients weighing more than 60 kg who tolerate the 50 mg dose but require additional glycemic control. Doses above 100 mg three times daily are not recommended.

Precautions

• Gastrointestinal symptoms (flatulence, diarrhea, abdominal pain) are common initially; these often diminish with continued use.
• Use with caution in patients with renal impairment (creatinine clearance <25 mL/min); miglitol is excreted renally.
• Not recommended in patients with significant digestive or absorptive disorders, such as inflammatory bowel disease or colonic ulceration.
• Monitor renal function periodically in patients with pre-existing renal conditions.
• Hypoglycemia may occur when Glyset is used in combination with sulfonylureas or insulin. In such cases, glucose (dextrose) must be used for treatment, as sucrose hydrolysis is inhibited.

Contraindications

• Hypersensitivity to miglitol or any component of the formulation.
• Diabetic ketoacidosis.
• Inflammatory bowel disease, colonic ulceration, or partial 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 effect

The most commonly reported adverse reactions are gastrointestinal and result from increased carbohydrate fermentation in the colon:

• Flatulence (41.5%)
• Diarrhea (28.7%)
• Abdominal pain (11.7%)
• Rash (4.1%) Less common side effects may include:
• Transient elevations in serum transaminases
• Headache
• Dizziness

Drug interaction

• May reduce the bioavailability of ranitidine and propranolol; administer these drugs at least 2 hours apart from Glyset.
• Digestive enzymes (e.g., amylase, pancreatin) may reduce the effect of Glyset and should not be used concomitantly.
• Charcoal-containing preparations may adsorb miglitol and reduce its efficacy.
• When used with sulfonylureas or insulin, may increase the risk of hypoglycemia.

Missed dose

If a dose is missed, it should be omitted if it is almost time for the next scheduled dose. Do not double the dose. Resume the regular dosing schedule with the next meal.

Overdose

An overdose of Glyset is not expected to produce hypoglycemia. However, it may result in transient increases in flatulence, diarrhea, and abdominal discomfort. There is no specific antidote. Treatment should be supportive and symptomatic. Hemodialysis may be effective due to the low molecular weight and water solubility of miglitol.

Storage

Store Glyset tablets at controlled room temperature, 20°C to 25°C (68°F to 77°F), in a dry place. Keep the bottle tightly closed and protect from moisture. Keep out of reach of children.

Disclaimer

This information is intended for educational and professional use only and does not replace clinical judgment or direct consultation with a qualified healthcare provider. Patients should always follow the advice of their prescribing physician and read the accompanying medication guide. Dosage and administration may vary based on individual patient factors.

Reviews

Glyset has been evaluated in multiple clinical trials and is recognized for its efficacy in reducing postprandial hyperglycemia. In a 1-year placebo-controlled study, Glyset 100 mg three times daily reduced HbA1c by an average of 0.7% compared to placebo. Gastrointestinal side effects were common but often decreased over time. It is considered a valuable option for patients who require targeted postprandial control without significant risk of hypoglycemia. Many clinicians appreciate its complementary mechanism of action and use it effectively within combination regimens.