In clinical work, I often have patients ask me: “Dr. Yuan, should I take my medication for diabetes before or after meals?” In fact, this is a very important question, which is sometimes crucial for our blood sugar control to reach the standard. In the same patient, due to the time of taking the drug or the physical state, it may have an impact on the absorption, hypoglycemic effect and the number of side effects. These drugs are mainly used to lower blood sugar by stimulating the release of insulin from pancreatic B cells, and are divided into sulfonylureas and non-sulfonylureas. Sulfonylureas are divided into long-acting and short-acting classes. The short-acting class includes glipizide (Mebendazole), glipizide (Glucophage), etc., which need to be taken half an hour before three meals. Long-acting formulations include gliclazide extended-release tablets (Damacell extended-release tablets, in 30 and 60 mg sizes), glibenclamide (Eugenol), glipizide controlled-release tablets (Rexin, 5 mg tablet), and glimepiride (Amoxicillin, 2 mg tablet). Long-acting dosage forms are taken once daily, usually half an hour before breakfast, unless specifically requested by your doctor. It is important to note that the slow-release or controlled-release formulations should not be broken or chewed, otherwise the long-acting effect of “slow-release” or “controlled-release” will not be achieved. Non-sulfonylurea drugs that promote insulin secretion are also known as glinides or “mealtime glucose regulators”, commonly used are Repaglinide (Novalax, Vulaid), Naglinide (Tangli) and so on. This kind of drugs can promote insulin secretion quickly and short-acting, can be taken orally before or during meals, such as no meals do not need to take drugs, this kind of drugs for the control of post-prandial hyperglycemia effect is better. The second type of drugs, biguanide drugs biguanide drugs are widely used, the current application is mainly metformin. These drugs do not directly stimulate the secretion of insulin, generally there is no special strict restriction on the time of taking the drug, it can be taken before, during or after meals; some patients will have more obvious gastrointestinal side effects after taking it, such as nausea, vomiting, diarrhea, etc. If the drug is taken after or during meals instead, the gastrointestinal reaction can be reduced and the efficacy of the drug is not affected. Metformin extended-release tablets, gastrointestinal reactions are slightly weaker, and there is no strict restriction on the time of taking the drug. The third class of drugs, thiazolidinediones mainly includes rosiglitazone (Vindia, Tylenol), pioglitazone hydrochloride (Ecto, Caspian), etc.. Like metformin, it does not directly stimulate insulin secretion, but exerts a stable and long-lasting hypoglycemic effect by increasing insulin sensitivity. These drugs are usually taken once a day at the same time, both before and after meals. Our national Food and Drug Administration has some restrictions on the application of rosiglitazone, so for information on this, consult an endocrinologist. The fourth category, a-glucosidase inhibitors Such drugs, represented by acarbose (Byosaprine, Carboprine), work by delaying the absorption of carbohydrates in the small intestine and mainly control postprandial hyperglycemia, especially for Chinese people whose diet is mainly carbohydrates, and many people in Henan Province are mainly noodle market and thus have a high carbohydrate intake. The drug requires taking with the first bite of food chewed at mealtime. It should be noted that taking this type of drug requires direct oral or intravenous injection of glucose in case of hypoglycemic reaction, while oral consumption of bread, cookies and other foods will not achieve the effect of rapidly raising blood sugar because they cannot be absorbed immediately. Fifth category. Insulin and related preparations ①Short-acting insulin (such as Eugenol R, Novolin R): subcutaneous injection 20-30 minutes before three meals. ②Ultra-short-acting insulin analogues (e.g. Novalurin, Eugenol): subcutaneous injection immediately before three meals. ③Medium-acting insulins (such as Novolin N, Eugenol N): according to the needs of the disease, generally once a day, subcutaneous injection before bedtime, or can be given twice a day according to the needs of the disease. ④ Premixed insulin: Generally 2 times a day according to the need of the disease. Short-acting insulin + medium-acting insulin (e.g. Eugenol 70/30, Novolin 30R, Novolin 50R) should be injected subcutaneously 20-30 minutes before meals; ultra-short-acting insulin analogues + medium-acting insulin (e.g. Novolac 30) should be injected subcutaneously immediately before meals. Note that premixed insulin should be shaken well before each use. ⑤ Basal insulin (e.g. Lysine): Generally, it should be injected subcutaneously at the same time point once a day, regardless of the meal time. Other: The new drug enteral insulin exenatide is usually injected before breakfast and dinner, mainly for controlling postprandial blood sugar, and attention should be paid to appropriate light diet when applying. We should pay attention to the “details” and arrange the medication time reasonably according to the characteristics of the mechanism of action of different drugs, so that we can achieve twice the result with half the effort and reduce the effect of adverse drug reactions.