Type 1 diabetes
- if a patient is on Insulin, they must not stop it due to the risk of Diabetic Ketoacidosis
- check blood glucose more frequently, for example, every 1-2 hours including through the night
- consider checking blood or urine ketone levels regularly
- maintain normal meal pattern if possible
- if appetite is reduced meals could be replaced with carbohydrate-containing drinks (such as milk, milkshakes, fruit juices, and sugary drinks)
- aim to drink at least 3 L of fluid (5 pints) a day to prevent dehydration
Type 2 diabetes
- advise the patient to temporarily stop some oral hypoglycaemics during an acute illness
- medication may be restarted once the person is feeling better and eating and drinking for 24-48 hours
- Metformin: stop treatment if there is a risk of dehydration, to reduce the risk of lactic acidosis.
- sulfonylureas: may increase the risk of Hypoglycaemia
- SGLT-2 inhibitors: check for ketones and stop treatment if acutely unwell and/or at risk of dehydration, due to the risk of euglycaemic DKA
- GLP-1 receptor agonists: stop treatment if there is a risk of dehydration, to reduce the risk of AKI
- if on Insulin therapy, do not stop treatment, as above
- monitor blood glucose more frequently as necessary