In addition, alcohol, aspirin, chloramphenicol, cholestyramine, cimetidine, clofibrate, cortisone, dicumarol, doxepin, fenfluramine, gemfibrozil, hydrochlorothiazide, oxytetracycline, phenelzine, phenylbutazone, propanolol and sulphamethizole may interact with any oral hypoglycaemics to cause severe adverse effects (AMA Drug Evaluations, Chicago: AMA, 1991).

For example, Diabetes UK says that metformin taken with alcohol or a sulphonylurea could trigger a 'hypo'). They also say that thiazolidinediones should only be used in combination with either a sulphonylurea or metformin, and should not be used on their own to avoid the possibility of liver damage. And as with metformin, acarbose (Glucobay, the only one in the UK), a gut maltase inhibitor, can bring on 'hypos' if taken with a sulphonylurea.

Your doctor may also try different combinations and doses of diabetes pills if it's thought that one of them alone cannot control your blood glucose level well enough.

Unlike insulin and pills, however, a diet carries no risk of low blood sugar or any other serious complications. Oral hypoglycaemics should therefore only be used by type 2 diabetics whose blood sugar is not controlled by diet alone and who cannot inject insulin.

If you do take a diabetes pill, you should make sure that you are taking the safest one possible. However, to prevent doctors from being tempted to follow a 'treatment of laziness'prescribing tablets if they think it's going to be too difficult for you to change your dietary habits or lifestyle you've got to become your own expert. Effective diabetes control hinges on your ability to manage the disease yourself.

!AClive Couldwell