When should I take my diabetes medication, before or after meals?

This is the 3176th article of Da Yi Xiao Hu

Diabetes is a common chronic disease. According to relevant research, the prevalence of diabetes in adults in my country has reached 12.8%. If people with prediabetes are included, nearly half of adults have abnormal blood sugar levels! Oral hypoglycemic drugs are the most commonly used means of hypoglycemic control and are widely used among diabetic patients. However, due to the wide variety of drugs, the time of taking each drug is different. Therefore, we often encounter patients holding medicine boxes and asking, "When should I take my hypoglycemic drug?"

What are the oral hypoglycemic drugs?

At present, the commonly used oral hypoglycemic drugs in China can be divided into 6 categories:

In addition, there are some compound hypoglycemic drugs, which combine two oral hypoglycemic drugs with different mechanisms of action into one, to complement each other's mechanisms, increase efficacy, reduce adverse reactions, and improve patient compliance. Representative drugs include: metformin + insulin sensitizer (rosiglitazone tablets/metformin tablets), metformin + DDP-4 inhibitor (sitagliptin/metformin tablets).

Time to take various hypoglycemic drugs and precautions

1. α-Glucosidase inhibitors

Time to take: Take with the first bite of each meal.

Note: The main adverse reactions after taking the medicine are flatulence, diarrhea and abdominal discomfort. The intensity of the reaction is usually related to the dose taken and is mostly mild.

2. Biguanides

Time of taking: Since taking metformin may cause gastrointestinal reactions such as nausea, vomiting, and stomach discomfort, it is generally recommended to take metformin during or immediately after meals.

Note: ① Avoid drinking alcohol during medication, as alcohol increases the risk of lactic acidosis and hypoglycemia. ② Patients with insufficient dietary intake or poor absorption need to monitor blood routine (recommended at least once a year). Metformin can reduce absorption and cause anemia or peripheral neuropathy. ③ Metformin should be discontinued before intravenous administration of iodinated contrast agents.

3. Sulfonylureas

Time of taking: Second-generation drugs (glipizide, gliclazide, glibenclamide, gliquidone) should be taken 15-30 minutes before meals, and third-generation drugs (glimepiride) should be taken at breakfast or the first main meal.

Note: Glycated hemoglobin (A1C) should be measured every 3-6 months during medication. For patients with impaired renal function, creatinine should be measured every 6-12 months.

4. Meglitinides

Time of use: Take within 15 minutes before a meal or immediately before a meal

Note: To assess long-term blood sugar control, glycated hemoglobin (A1C) should be measured every 3-6 months.

5. Insulin sensitizers

Taking time: Regardless of meals, take at regular times daily.

Note: ① Liver function should be monitored regularly during medication. ② Patients whose blood sugar meets the target should measure glycosylated hemoglobin (A1C) at least twice a year, and patients whose treatment changes or whose blood sugar does not meet the target should increase the frequency of testing (4 times a year). ③ Insulin sensitizers can increase the risk of weight gain, fluid retention, heart failure, and fractures, and may also slightly increase the risk of bladder cancer (pioglitazone), so they are not the first choice for type 2 diabetes.

6. Dipeptidyl peptidase 4 (DPP-4) inhibitors

Taking time: Regardless of meals, take at regular times daily.

Note: Some DPP-4 inhibitors (such as saxagliptin and alogliptin) may increase the risk of hospitalization for heart failure in patients, and regular electrocardiograms are required.

7. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors

Taking time: Regardless of meals, it is recommended to take it on an empty stomach in the morning.

Note: Observe for signs and symptoms of genitourinary tract infection and foot ulcers during medication, and monitor renal function regularly.

What else should diabetics pay attention to besides taking medication as prescribed by their doctor?

We need to know that there is a "five-horse" principle for the treatment of diabetes. The so-called five-horse means that the treatment of diabetes is not a single treatment, but a comprehensive treatment. The five-horse includes: diet, exercise, medication, education and self-monitoring. Therefore, in addition to taking medication, you also need to:

diet

On the basis of ensuring adequate calories and nutrition, limit the intake of salt, carbohydrates, fat and protein, reasonably match meals, choose diversified and nutritious foods, eat small meals, eat at regular times and quantitatively, quit smoking and drinking, and drink more water. How much food can you eat every day? We can stretch out our hands: you can eat 2 fist-sized carbohydrates such as steamed buns, flower rolls, rice, etc.; 1 fist-sized fruit; 1 palm-sized protein; 1 thumb-tip fat; 1 finger-thick and 2 finger-wide lean meat; 2 hands can hold the amount of vegetables.

sports

First of all, not all patients are suitable for physical exercise. Diabetic patients with limited mobility and serious underlying diseases should avoid exercise as much as possible. Before doing physical exercise, you need to prepare. Schedule the time 60-90 minutes after a meal; prepare suitable sports shoes and cotton socks, pay attention to airtightness and permeability; choose a suitable sports venue, find a suitable sports partner, and carry a diabetes rescue card with you; do warm-up exercises to adapt the cardiovascular system and improve the activity effect of joints and muscles. For exercise methods, it is best to consult a specialist and choose a safe and effective exercise method based on your own situation, usually low- and medium-intensity aerobic exercise, including walking, jogging, swimming, skipping rope, etc.

Education and self-monitoring

In daily life, actively learn preventive health care knowledge related to diabetes, monitor blood sugar regularly, and avoid complications such as diabetic foot.

References:

[1] Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ. 2020;369:m997.

[2] Francesco C, Grant PJ, Victor A, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020 Jan 7;41(2):255-323.

[3] Doyle-Delgado K et al. Pharmacologic approaches to glycemic treatment of type 2 diabetes: Synopsis of the 2020 American Diabetes Association's standards of medical care in diabetes clinical guideline. Ann Intern Med. 2020 Nov 17;173(10):813-821.

[4] National Geriatrics Center, Chinese Medical Association Geriatrics Branch, Chinese Geriatrics Association Diabetes Professional Committee. Guidelines for the diagnosis and treatment of diabetes in the elderly in China (2021 edition)[J]. Chinese Journal of Diabetes, 2021, 13(1):14-46.

Chinese Medical Association Diabetes Branch. Chinese Diabetes Exercise Guidelines[M]. Beijing: Chinese Medical Electronic Audio-visual Publishing House, 2012.

Author: Zhejiang Provincial Hospital of Traditional Chinese Medicine

Fan Ting, Wang Jianping