1. Diabetes is a chronic disease. It is a condition when your
level of sugar in blood is higher than normal.
Normal Blood Sugar : < 7.8 mmol/L
According to International Diabetes Federation (IDF),
there are 3.2 million cases of Diabetes in Malaysia in
2014 and one-in-five adult Malaysia over 30 already a
diabetic.
HOW DIABETES OCCURS?
Diabetes occurs when your body cannot produce insulin
or cannot use insulin effectively. Insulin is a hormone
made by beta cells in pancreas. The function of insulin is
to bring down blood sugar level to normal after eating.
Then, insulin transports sugar in blood stream into the
cell or tissues, allows body to convert sugar from carbo-
hydrate to form energy. Insulin defect or insufficiency
does not allow the glucose to transport into the cells to
be used as energy. Glucose accumulated in the blood
and cause sugar in blood rises.
WHAT IS DIABETES?
FOOD DRUG INTERACTION
A food drug interaction is defined as ―any interaction between drugs with foods or beverages or a drug induce the
effect on nutritional intake‖. The result of drug interaction with food make the medications less effective, cause
unexpected side effects, or increase the action of a particular medications. Before we go to the food-drug interac-
tion, let’s understand about Diabetes.
DIABETES
FOOD DRUG INTERACTION
3.2 million
Cases of Diabetes in Malaysia in
2014
Type of Diabetes
Type 1 Type 2
 The body does not pro-
duce insulin because be-
ta cell in pancreas are
damaged or destroyed.
 Unaffected by lifestyle or
eating habit.
 Usually occurs in children
or young adult.
 Insufficient insulin or
resistance of tissue to
insulin.
 Sedentary lifestyle and
bad eating habit can
cause diabetes.
 Common in adult and
obese people.
Symptoms
 Thirsty, dry mouth
 Frequent urination
 Weight loss
 Fatigue
 Blurred vision
 Often no symptoms at
the beginning
 Blurred vision
 Thirst/ dry mouth
 Frequent urination
 Leg pain
Medication
Insulin injection Oral Anti-Diabetic Agent
MEDICATIONS AND THEIR INTERACTION
There are many types of medications available in
the market to treat diabetes. Each medications have
different mechanism of action (MOA). Besides, the
time taken is important to prevent side effect. The
most common side effect is hypoglycaemia (a condi-
tion when blood sugar is too low). Hypoglycemia
usually occurs if no food is eaten within 30 minutes
after medication ingested. In other way, if food taken
before administration of drugs, it may reduce the
effectiveness of drug.
Here's an at-a-glance comparison of common diabe-
tes medications and their interaction:
This picture shows how insulin works. Credit photo form NNM Booklet for DM.

2. INSULIN INJECTION
People with type 1 diabetes need insulin to
allow their body to process glucose as they cannot
make insulin. Person with type 2 diabetes may first be
treated with oral medication, along with diet and exer-
cise. They may need insulin shots to help them better
process sugar and to prevent long-term complication
from this disease. Insulin need to be prescribed by the
doctors based on medical history and allergies.
Insulin are differ based on onset (when the
insulin begins to work), peak (when it is working at the
maximum), and duration of action (how long it works).
There are two common type of insulin that are used to
treat diabetes, such as:
CONCLUSION
The effectiveness of a drug is a very important concern to ensure diseases are well controlled. Therefore, always remem-
ber of any possible food-drug interaction that may occur when consuming them. Be sure to follow the useful tips to avoid
unnecessary effects and to get the best of your medication. Do not be hesitant to approach you healthcare provider if you
have any questions and concerns about possible drug interactions.
Dipeptidyl peptidase 4 (DPP-4)
Example of medicine: Sitagliptin
MOA : Increase insulin release and decrease
glucagon levels in the circulation.
Time Taken : Take with or without main meal.
Side effect : Gastrointestinal problems – including
nausea, diarrhea and stomach pain.
Suggestion : Choose plain food, avoid sweet,
greasy, spicy and odor food. Limit caf-
feine and alcohol intake.
Alpha glucosidase inhibitor
Example of medicine: Acarbose
MOA : Reduce blood sugar by decrease the
rate absorption.
Time Taken : Taken with main meal (first bite of
meal).
Side effect : Bloating, abdominal discomfort, diar-
rhea & flatulence.
Suggestion : To lessen the side effect, eat slowly,
avoid gum and hard candies. Limit
the foods that cause gas such as
fruits and vegetables, whole grains,
packaged foods—such as bread,
cereal and milk products.
Thiazolidinediones (TZDs)
Example of medicine: Rosiglitazone
MOA : Increase insulin sensitivity of muscle,
and fat tissue.
Time Taken : Take with or without main meal.
Side effect :  Increase in fat deposition cause
weight gain.
 Fatigue & fluid retention.
Suggestion :  To prevent weight gain, small and
frequent meal & snack is advisable
and limit fried and fatty food. Limit
amount of fluid intake.
 To avoid fluid retention, reduce salt
intake and eat potassium rich foods
such as medium banana, a cup of
almond and carrot.
Biguanides
Example of medicine: Metformin
MOA : This drug does not stimulate insulin se-
cretion and decrease production glu-
cose from the liver.
Time Taken : Take with meals or immediately after.
Side effect :  Gastrointestinal disturbance such as
diarrhea, nausea & anorexia.
 Anemia may happened because of
vitamin B12 deficiency.
Suggestion : Choose plain food, avoid sweet, greasy,
spicy and odor food. Increase intake of
fluid and high potassium food such as 1
whole medium banana.
Sulfonylureas
Example of medicine: Glibenclamide / Gliclazide
MOA : Stimulate insulin secretion from pan-
creatic beta cell.
Time Taken : 30 minutes before meals.
Side effect :  May cause Hypoglycemia.
 Increase in appetite may promote
weight gain.
Suggestion : If hypoglycaemia happened, eat 1-
2 sweets or drink 1 cup of juice or
sweet beverage.
 Small and frequent meal to control
food intake and limit fried and fatty
food to prevent weight gain.
Type
Onset Of
Action
Peak
Action
Duration
Of Action
Time
Taken
Side Effects Suggestion
Rapid Acting
Actrapid
30 – 60
min.
2 – 4
hours
6 – 10
hours
30 – 60
min.
before
meals
 Hypoglycemia
 Swollen joints
 Weight gain
 Consume 1-2 sweets or drink a cup of
juice or sweet drink immediately.
 Control intake of water to reduce swol-
len joint.
 Eat regular meals and avoid skipping
meals.
Intermediate Acting
Insulatard
1 – 2
hours
4 – 8
hours
10 – 16
hours
Pre-
break-
fast/ pre-
bed
Hypoglycemia  Consume 1-2 sweets or drink a cup of
juice or sweet drink immediately.
 Eat regular meals and avoid skipping
meals.