Type 2 diabetes and work: how to fit your doses into your day

How to fit metformin and other type 2 diabetes treatments into a real working day, without overlooking hypos.

To fit type 2 diabetes medication into your working day, the most effective approach is to link each dose to a fixed meal (breakfast, lunch or dinner) and carry what you need in case your blood sugar drops. If you take medicines that can cause hypoglycaemia, not skipping meals is as important as not forgetting the tablet.

Meetings that overrun, late lunches, trips or changing shifts mean many people with diabetes miss doses or eat at irregular times. With a little planning, you can stick to your treatment without letting work rule your health.

When should I take each diabetes medicine?

It depends on the medicine, and the answer is in the leaflet. For example, the metformin leaflet says to take it with or after meals, to reduce stomach upset: one dose a day at breakfast, two doses at breakfast and dinner. Gliclazide, a sulfonylurea, is taken at breakfast and you must always eat afterwards; its leaflet stresses not skipping any meals.

Other groups of medicines have different schedules (some are weekly or injected). If you are unsure about yours, ask your pharmacist how and when to take them.

How do I fit my doses into a working day?

The key is to make each dose part of a routine you already have, instead of relying on memory. These tips work well for many people:

• Have breakfast at home whenever you can and take your morning medication there: it is the easiest dose to secure.
• If you eat at work, keep your midday dose in a small pill box next to your lunch box or in your bag.
• Set a discreet phone alarm at lunchtime with the name of the medicine.
• Keep something to eat in your desk drawer (fruit, nuts, a sandwich) in case a meeting delays lunch.
• Note long meetings or trips in your calendar and plan where you will eat.

If you need ideas for carrying your tablets without drawing attention, read how to take your medication to work discreetly.

What should I do if I feel a low at work?

If you take medicines that can cause hypoglycaemia and notice shaking, sweating, palpitations, intense hunger or difficulty concentrating, act straight away. The Clínica Universidad de Navarra and the CDC describe the "rule of 15":

1. If you can, check your glucose. Below 70 mg/dl is considered low; if you cannot check it, act as if it were.
2. Take about 15 grams of fast-acting sugar: for example, half a glass of juice or a sugary soft drink, a sachet of sugar or a glucose gel.
3. Wait 15 minutes and check again. If it is still below 70, repeat.
4. Once it is back to normal, have something with slow-release carbohydrates (for example, a small sandwich) to prevent another drop.

Do not drive or operate machinery until you have recovered. If the symptoms do not improve or the person is confused, get urgent help. Telling a trusted colleague what to do in that case will give you peace of mind.

Do I have to tell work? What if I work shifts?

You are not obliged to tell your colleagues about your diagnosis. Spain's Occupational Risk Prevention Act protects the confidentiality of information about your health and forbids using health surveillance data for discriminatory purposes. It also requires employers to give specific protection to people who are especially sensitive to certain risks because of their health, which the occupational health service assesses.

If you work rotating or night shifts, or drive for work, talk to your doctor and the occupational health service: your plan or meal times may need adjusting. The gliclazide leaflet, for example, asks you to consult your doctor about driving if you have frequent hypos or do not notice their symptoms. Our guide to remembering your tablets when you work shifts may also help.

A practical example: Luis, a sales rep with a packed diary

Take the case of Luis, 54, a sales representative with type 2 diabetes, high blood pressure and high cholesterol. He takes metformin at breakfast and dinner, gliclazide in the morning and two more tablets for blood pressure and cholesterol. He spends half the week on the road and often eats late.

Luis decides to always have breakfast at home and take all his morning medication there. In the glove box and his rucksack he keeps sugar sachets, a small carton of juice and some cereal bars. He sets an alarm at 14:00 to remind him to eat, even something light, because gliclazide means he must not skip meals.

At his next check-up he tells his nurse that on travel days he eats at odd times and that once he felt shaky at the wheel. Together they review his plan with his GP, who considers whether his treatment is still the best fit for his lifestyle.

How can IMA Health help you?

When your day is already full, filling pill boxes every week is one more job. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up. All you need to do is pick up the day's doses in the morning and take the lunchtime one with you. If you live with several long-term treatments, you may also be interested in how to avoid mistakes with type 2 diabetes medication.

Sources

• CIMA (AEMPS): leaflet for Metformina Cinfa 850 mg (in Spanish)
• CIMA (AEMPS): leaflet for Gliclazida Cinfa 30 mg (in Spanish)
• Clínica Universidad de Navarra: how to act in a hypo (in Spanish)
• CDC: treating low blood sugar (in Spanish)
• BOE: Law 31/1995 on Occupational Risk Prevention (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.