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Avandamet (Rosiglitazone, Metformin)


Energy need
When planning your therapy consider your energy need first. You should eat most before or during your times of greatest energy expenditure. If you are working a night shift, you need a good ‘breakfast’ in the evening and a substantial midnight meal.
When planning your insulin pattern it is helpful to think of the day as four separate periods: from getting up until the middle of the working day; the middle of the day until end of work; the end of work until bed-time; and sleeping. During this time you will have three meals, the first when you wake up, the second in the middle of the working day and the third at the end of the working day. You will also have snacks when necessary.
Insulin cover
Each of these periods of time needs insulin cover. Glucose balance on shift work is difficult to control on a once-daily insulin pattern. Either of the two most common patterns of insulin dosage can be adapted. Thus, rapid-acting and medium-acting insulin can be given in a larger dose to cover the larger meals and a smaller dose can be given for sleeping. The morning and evening quantities should be reversed when the waking and sleeping parts of the day are reversed. The other method is to use a very long-acting insulin as background and to add fast-acting insulin before breakfast and before your last big meal, adjusting the quantity as needed. On either regimen, extra doses of rapid-acting insulin can be added if necessary, before other meals or at times of changeover.
If you write down what you have done about meals and insulin and what effect it had on your blood glucose level you can use the successful regimen repeatedly as your shifts change during the year.

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