• See Also
  1. Diabetes Mellitus
  2. Type I Diabetes Mellitus
  3. Type II Diabetes Mellitus
  4. Insulin Resistance Syndrome
  5. Glucose Metabolism
  6. Diabetes Mellitus Education
  7. Diabetic Ketoacidosis
  8. Hyperosmolar Hyperglycemic State
  9. Diabetes Mellitus Control in Hospital
  10. Diabetes Mellitus Glucose Management
  11. Diabetes Sick Day Management
  12. Hypertension in Diabetes Mellitus
  13. Hyperlipidemia in Diabetes Mellitus
  14. Diabetic Retinopathy
  15. Diabetic Nephropathy
  16. Diabetic Neuropathy
  17. Coronary Artery Disease Prevention in Diabetes
  18. Tobacco Cessation
  19. Obesity Management
  • Management
  • General
  1. Diabetic action plan based on Blood Glucose Monitoring
  2. Early contact with medical provider when Glucose control acutely changes (see red flags listed below)
  • Management
  • Medications
  1. Metformin
    1. Stop when dehydrated (e.g. Vomiting, Diarrhea) and restart when resolves
    2. Risk of Lactic Acidosis (rare) with Dehydration
  2. SGLT2 Inhibitors
    1. Stop when dehydrated (e.g. Vomiting, Diarrhea) and restart when resolves
    2. Risk of Ketoacidosis and Acute Kidney Injury with Dehydration
  3. Insulin Secretagogues (Sulfonylureas, Repaglinide, Nateglinide)
    1. Hold for decreased intake and risk of Hypoglycemia
  4. Bolus Insulin (e.g. Regular, Lispro)
    1. Increase Bolus Insulin by 5-20% for consistent Blood Glucose >250 mg/dl
    2. Hold or decrease Bolus Insulin for inability to take Carbohydrates and risk of Hypoglycemia
    3. Consider smaller, more frequent Bolus Insulin doses (every 2-4 hours)
  5. Basal insulin (e.g. Lantus, Detemir)
    1. Continue basal dosing despite illness
    2. Consider decreased basal Insulin Dosing if inability to eat Carbohydrates
  6. Insulin Pump
    1. Make a back-up plan for Insulin Pump failure
  • Management
  • Labs
  1. Glucose
    1. Seek medical attention (or call) for Blood Glucose consistently >300 mg/dl on at least 2 consecutive checks
    2. Watch for Hypoglycemia (esp. with Nausea, Vomiting)
      1. Consider small servings of juice when unable to eat
    3. Increase Glucose monitoring while ill
      1. No Insulin: 2-4 times daily
      2. Insulin: every 2-4 hours
  2. Ketones or Beta Hydroxybutyrate (in Type I Diabetes Mellitus)
    1. Home Ketone monitoring while ill (especially with Blood Glucose >240 mg/dl)
  • Precautions
  • Red flags warranting repeat examination
  1. Prolonged Vomiting
  2. Inability to hold down fluids
  3. Presistent or Recurrent Hypoglcemia or Hyperglycemia
  • Prevention
  • Emergency Supplies
  1. Extra Insulin
  2. Glucagon
  3. Glucometer and test strips
  4. Ketone testing (urine or blood)
  5. Fast acting Glucose (e.g. juice, Glucose tablets)
  6. Syringes and needles (also in case of Insulin Pump failure)
  • References
  1. (2023) Presc Lett 30(6): 32-3
  2. (2012) Presc Lett 20(3): 13-14
  3. Smith (2018) Am Fam Physician 98(3): 154-62 [PubMed]
  4. Westerberg (2013) Am Fam Physician 87(5): 337-46 [PubMed]