When should diabetes medications be restarted?
Aim to restart the usual diabetes tablets, injectables and insulin regimen when there are no contraindications to their use. Medications may have restarted in hospital before discharge or after the patient has returned home. Ensure renal function is normal and the patient is eating without vomiting.
If glycaemic control is poor, consider adjusting the medication regimen to optimize glucose control. (See Outpatient care of Type 2 Diabetes, how to improve glycaemic control).
If steroids were started in hospital or if the usual doses were increased, the insulin doses should be reduced in parallel with any dose changes of the steroids. If steroids are being weaned the insulin doses should be weaned or ceased to avoid hypoglycemia.
Insulin was started in hospital. What now?
Insulin may be required temporarily after the patient has been discharged from hospital as the illness resolves. Insulin doses need to be weaned as the glucose levels decrease.
In patients with type 2 diabetes, aim to simplify the insulin regimen to basal only insulin if possible. Unless there are contraindications to their use, restart the diabetes tablets to reduce the insulin dose requirements and optimize glycaemic control. Continue insulin long term if:
In patients with type 1 diabetes, continue the basal bolus insulin regimen but adjust the doses to avoid hypoglycaemia and stabilize glucose levels.
Strategies that reduce the insulin dose requirement include:
Basal bolus insulin was started in hospital. What now?
Continue the insulin regimen in the following situations:
Otherwise, aim to simplify or cease the insulin regimen for patients with Type 2 Diabetes. Contact the Endocrinologist or Diabetes team for further advice regarding insulin if you are unsure whether the insulin regimen should continue or how to adjust the doses.