I have been prescribed tablets to control my diabetes. When should the tablets be taken, before or after the meals?
Ans. Sulphonylureas (Daonil, Diabenese, Glizid, Glynase, Amaryl, etc.) should be taken just before meals, whereas Biguanides (Glycomet, Obimet, Gluformin, etc.) should be taken after the meals. In practice, it is immaterial if biguanides are taken along with sulphonylureas just before the meals, unless it causes some gastric side effects. Fibre (Carbotard) or Acarbose (Glucobay) must be taken before meals, as it directly acts in prevention of absorption or digestion of food. Taking tablets before meals, at least ensures its compliance as there are less chances of forgetting it.
Q4. I am 55 years old, have had diabetes for the last 10 years. So far I have maintained a good control of diabetes, and have no complications. But recently, I have been prescribed insulin as the blood sugar has been rather high. I wonder if I start insulin once, I will have to take it life long. Is that true?
Ans.No, not necessarily. Insulin is normally prescribed in type II diabetes cases when:
i. Diabetic control has been lost due to some concurrent acute illness like infections such as pneumonia, urinary infection or tuberculosis and other stressful situations like surgery, or presence of some complications.
ii. There is poor control of diabetes in spite of a balanced diet, regular exercise and maximum dose of oral hypoglycemic agents (tablets), i.e.; secondary failure of oral agents.
iii. In pregnancy if your diabetic control is lost due to non-compliance or irregular treatment, any concurrent illness, or pregnancy, insulin is given for a short period to achieve a good control, later on you could be shifted to tablets again.
If the control of diabetes is of temporary nature, once pancreatic B cells are rested with insulin treatment, and ill-effect of high blood sugar is eliminated, one may expect to return to tablets again.
But if it is due to secondary failure of oral tablets, chances are that you have to continue insulin for longer period, as your own insulin production has deteriorated to a greater extent, and is less likely to recover.
It is better to take insulin and enjoy a better quality of life, rather than try to avoid insulin. Today insulin injections are so convenient and virtually painless. Once you feel the good effect of insulin, you may yourself not like to leave it.