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Diabetes mellitus
Sick day rules for people on oral hypoglycaemic agents
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Principle: To provide guidelines for use by health care professionals to
assist people on hypoglycaemic agents alone or combination therapy i.e.
hypoglycaemic agents and insulin to manage intercurrent illness.
Metformin only
- Stop in acute illness.
- Monitor BMs x 4 hourly or increase urine testing for sugar.
- NB: Contact GP surgery if BM over 13 and/or unwell.
- Consider introducing sulphonylurea on a temporary basis (le. Tolbutamide
500mg bd initially).
- May need insulin during episodes of more severe illness.
Metformin and Sulphonylurea
- Stop Metformin in acute illness.
- Monitor BMs x 4 hourly or increase urine testing for sugar.
- Contact GP surgery if IBM over 13 or unwell. Discuss possibility of
increasing sulphonylurea up to maximum dosage (ie. Tolbutamide: ig bd,
Gliclazide: l60mgs bd, Glibenclamide: l5mgs daily).
- May need insulin during episodes of severe illness.
Sulphonylurea only
- Monitor BMs x 4 hourly or increase urine testing for sugar.
- Contact GP surgery if BM over 13 or unwell to discuss possibility of
increasing Sulphonylurea to maximum dose (ie. Tolbutamide: ig bd,
Gliclazide: 160mgs bd, Glibenclamide: 15mg daily).
- May need insulin during episodes of severe illness.
NB: When illness subsides reduce sulphonylurea to normal dose. Metformin
should be restarted at 500mg daily for 1 week. Step up to normal dose in
500mgs/week.
People on insulin and an oral agent must be prescribed Ketostix and Actrapid
Insulin when insulin is started.
Metformin and Insulin
- Stop Metformin in acute illness. Refer to 'Insulin
sick day rules'.
- Monitor BMs x 4 hourly.
- Check for ketones.
Metformin, Sulphonylurea and Insulin
- As above.
- Sulphonylurea unchanged.
if nauseated or vomiting and unable to take oral medication. Consider
prescribing antimetic.
Source: Northumbria NHS Health Care Trust diabetes protocol