The stress hormones that rise during acute illness will cause hyperglycemia in people with pre-diabetes and type 2 diabetes. Hyperglycaemia itself impairs the immune response, so recovery can be slower and more complicated than if glucose levels are well controlled. Persistent hyperglycemia increases your patients risk of dehydration.
Sick Day Plan
When your patient is sick and glucose levels are higher than normal, they can implement a sick day plan, which involves:
How to handle medications
If your patient is dehydrated or deteriorating, refer him/her for IV fluids in hospital.
Dehydration and sepsis increases the risk of medication-related side effects, so these should be withheld until the illness is resolved and renal function is normal:
Of course, the glucose levels may rise in response to ceasing these medications and the illness itself.
Insulin dose adjustments
If glucose levels are not elevated during illness, your patient should continue their usual doses. Basal insulin (Lantus, Toujeo and pre-mixed insulin) should continue, even if the patient is not eating.
If the illness or stress is associated with hyperglycemia, plan to increase the insulin doses for the period of illness.
When to refer your patient to hospital
Consider referring your patient to hospital for definitive investigation and management when your patient is suffering: