Sick Day Rules

Question 1

When can medications be restarted?

Answer 1

Once patient is feeling better and is eating and drinking for 24-48 hours.

(Unless there are concerns about renal function)

Question 2

What non-diabetic drugs should be stopped? And Why?

Answer 2

ACE inhibitors and ARBs
Diuretics
NSAIDs

Stop if risk of dehydration to reduce chances of AKI.

Question 3

Should metformin be stopped? Why?

Answer 3

Stop if there is a risk of dehydration

Reduce risk of lactic acidosis*

*Renal impairment - reduced metformin clearance - lactic acid builds up in blood stream - life threatening

Question 4

Should sulfonylureas be stopped? Why?

Answer 4

Increase risk of hypoglycaemia, particularly if dietary intake is reduced.

Question 5

Should sulfonylureas be stopped? Why?

Answer 5

Increase risk of hypoglycaemia, particularly if dietary intake is reduced.

Question 6

Should SGLT-2 inhibitors be stopped? Why?

Answer 6

Check for ketones and stop treatment if acutely unwell and/or at risk of dehydration.

Due to risk of euglycaemic diabetic ketoacidosis.

Question 7

Should GLP-1 Receptor agonists be stopped? Why?

Answer 7

Stop if risk of dehydration to reduce risk of AKI.

Question 8

Should insulin therapy be stopped?

Answer 8

No.

Dose may need to altered

Seek specialist advice.

Question 9

What should the patient do if they self-monitor glucose levels in the even of illness?

Answer 9

Increase monitoring frequency (3-4 hourly), including through the night.

Insulin dose adjustments may be required.

Seek urgent medical advice if glucose levels remain uncontrolled.

Question 10

Other advice to diabetic patients

Answer 10

Blood or urinary ketone monitoring (hyperglycaemia) (3-4 hourly)

Maintain normal meal pattern (including fluids and carb intake)
If vomiting, replace normal meals with carb-containing drinks.