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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Other glucose-lowering drugs

Smaller groups for type 2 (and type 1) diabetes: drugs that slow carbohydrate digestion, short-acting insulin secretagogues and an amylin analogue.

Updated 2026-11-01

## What they are

Alpha-glucosidase inhibitors (acarbose), meglitinides (repaglinide) and amylin analogues (pramlintide). Each targets mainly the glucose rise after meals.

## Mechanism of action

Acarbose blocks the brush-border alpha-glucosidases that split starch and sucrose, so carbohydrate is absorbed later and more slowly. Repaglinide closes the beta-cell KATP channel like a sulfonylurea but at a different site of SUR1, with a quick, short action around meals. Pramlintide copies amylin, a beta-cell hormone that slows gastric emptying, reduces glucagon after meals and increases fullness.

Target: Intestinal alpha-glucosidases, SUR1 of the KATP channel, amylin receptors

## Key points

- Hypoglycemia on acarbose plus insulin or a sulfonylurea is treated with glucose (dextrose), not table sugar, because sucrose digestion is blocked.
- Acarbose: flatulence, bloating and diarrhea from carbohydrate fermented in the colon.
- Repaglinide is contraindicated with gemfibrozil (CYP2C8 inhibition, severe hypoglycemia).
- Pramlintide is used with mealtime insulin and can cause severe hypoglycemia in the hours after injection.

## Drugs in this class

- [**Acarbose** An oral drug that slows carbohydrate digestion in the gut, so glucose rises less after meals. Flatulence is the usual… Intestinal alpha-glucosidases (maltase-glucoamylase, sucrase-isomaltase) and pancreatic alpha-amylase](https://durgical.com/en/pharmacology/acarbose/)
- [**Repaglinide** A short-acting meglitinide taken just before meals: it gives a quick burst of insulin. Never combined with gemfibrozil. Sulfonylurea receptor 1 (SUR1) of the KATP channel](https://durgical.com/en/pharmacology/repaglinide/)
- [**Pramlintide** An injected copy of amylin, a beta-cell hormone, used with mealtime insulin. It can cause severe hypoglycemia in the… Amylin receptors (calcitonin receptor with RAMP proteins)](https://durgical.com/en/pharmacology/pramlintide/)

## Others in the class

- miglitol (alpha-glucosidase inhibitor)
- nateglinide (meglitinide)
- voglibose

## Test yourself

Think of the answer, then tap the question to see it.

## Why is table sugar a poor treatment for hypoglycemia in a patient on acarbose?

Sucrose must be split by intestinal alpha-glucosidases before absorption, and acarbose blocks them; glucose is absorbed directly.

## How does repaglinide differ from a sulfonylurea?

Both close the beta-cell KATP channel, but repaglinide is not a sulfonylurea, binds a different site and acts quickly and briefly, so it is given with meals.

## Which hormone does pramlintide copy, and which cell normally makes it?

Amylin, released by the pancreatic beta cell together with insulin.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ACARBOSE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1ba7a072-03b0-41f2-be7a-101145bdef3a) (DailyMed (U.S. National Library of Medicine), 2026); [DailyMed - REPAGLINIDE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6ae28683-28cc-408e-90f9-6a3dddfc668d) (DailyMed (U.S. National Library of Medicine), 2026); [Pramlintide Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a605031.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/other-glucose-lowering-drugs/