TREATMENT OF DIABETES: PILLS REDUCING THE BLOOD GLUCOSE LEVEL
Because pills have to be absorbed from the gut before they can work, anything that upsets absorption may interfere with their action. This may include a stomach or bowel operation years ago. Diarrhea and vomiting are obvious problems but taking them after a big meal may delay absorption. Some foods may slow their absorption more than others. Taking them on an empty stomach can irritate the stomach in some people. You must never take them and then not eat. Instructions for taking sulphonylureas vary depending on which book one reads. Most suggest with the meal – I interpret this as swallowing them when you have eaten some, but not all of your food – for example, between the cereal and the toast, or, at dinner time, between the soup and the main course. Wash your pills down with a drink of water or other non-alcoholic beverage.
If your pills are prescribed twice a day, then take them twice a day. With oral hypoglycemic pills this usually means with breakfast and with your evening meal – but if you are taking tolbutamide or glipizide it may mean with breakfast and lunch – so ask your doctor. It is rare to need more pills with the evening meal than with the morning meal. Too much sulphonylurea at night increases the risk of nocturnal hypoglycemia. But I do see one man who eats very little in the day and a great deal in the evening who needs 80 mg gliclazide with breakfast and 160 mg gliclazide with his evening meal. This sort of adjustment is only possible in someone who is monitoring their blood glucose carefully. If you take your pills at the wrong time, or take them all at once when you have been advised to divide them you run the considerable risk of hypoglycemia.
Getting the best out of your treatment
• Diet is the basis of all treatment for diabetes.
• If you are on additional treatment learn everything you can about it.
• If you are taking insulin:
1. Learn how fast and for how long each of your insulins acts – both theoretically and in your own case.
2. Gain confidence in adjusting your own insulin dose.
3. Consider advances in insulin injection techniques.
4. Consider whether you have injection site problems.
• If you are taking oral hypoglycemic pills:
1. Learn how fast and for how long your pills act.
2. Learn the maximum safe dose of your pills and consider making adjustments within this maximum.
• Do not be upset if you cannot control your diabetes on pills and diet. The need for insulin treatment is not a disaster and you will learn how to cope with it very quickly.
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