The biggest hurdle for many of my patients with type 2 diabetes has always been the idea of injections. So when Rybelsus became available, it was a major development because it offered the power of a modern medication in the simple form of a pill. Its main job is to control blood sugar, and it does this in a couple of very smart ways. First, it signals your pancreas to release insulin only when your blood sugar starts to rise after a meal, which is much safer than older medications. Second, and this is the part that gets everyone's attention, it significantly slows down the speed at which food leaves your stomach. This has the direct effect of making you feel full much sooner and for a much longer period of time. This physical feeling of fullness, combined with the way the drug works on the appetite centers in the brain, almost always leads to weight loss, which is a huge additional benefit for most people with type 2 diabetes.

The most important conversation I have with patients about Rybelsus is not about what it does, but about the very strict rules for taking it. This is not a pill you can just swallow with your other morning vitamins. For it to work at all, it has to be the very first thing you put in your mouth when you wake up, on a completely empty stomach. You take it with just a small amount of plain water, about half a small glass. After you swallow it, you have to wait at least thirty full minutes before you eat, drink anything else, or take any other medication. These rules are not suggestions. The medicine is fragile, and if it mixes with food, coffee, or other pills in your stomach, it will not be absorbed and you will get no benefit. I tell my patients that following this morning routine is the key to success with this medication, and we also talk about managing the initial side effects, which are most often a feeling of nausea as your body gets used to the slowed digestion.

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