Planning sick-day management for type 2 diabetes

Sick days are defined as periods of an acute illness (usually 1 to 14 days duration) that require changes to a patient’s usual diabetes self-management practices. A fact sheet about sick-day management for patients with type 2 diabetes is available from the National Diabetes Services Scheme (NDSS) website.

All patients with type 2 diabetes should be taught that acute illness can have a significant impact on their diabetes and blood glucose concentrations.

Sick-day management plans must be individualised. Consider the patient’s:

• usual antihyperglycaemic drug treatment (including whether they are using insulin)
• ability to monitor their blood glucose concentrations and adjust treatment
• severity of illness and whether referral to hospital is needed for treatment of the acute illness or complications due to hyperglycaemia
• comorbidities, organ function and risk of deterioration (eg underlying kidney impairment could deteriorate if hyperglycaemia causes dehydration).

Not all patients with type 2 diabetes have a blood glucose meter or know how to monitor their blood glucose concentrations. Although self-monitoring of blood glucose concentrations may not be routinely required, it is useful for a patient to be able to self-monitor when they are unwell. Ideally, when the patient is well, self-monitoring blood glucose concentrations should be taught as part of developing a sick-day management plan. For further information, see Self-monitoring of blood glucose concentrations in adults with type 2 diabetes.

Severe hyperglycaemia can develop in patients with type 2 diabetes and an acute illness. Rarely, this may lead to hyperosmolar hyperglycaemia, which has a high mortality rate. For information about management, see Hyperosmolar hyperglycaemia in adults.

Although uncommon in patients with type 2 diabetes, diabetic ketoacidosis (DKA) can occur in patients with an acute illness. Risk of DKA is higher in patients who:

• are severely unwell
• are underweight
• have a substantially decreased carbohydrate intake (eg prolonged fasting, significant dietary carbohydrate restriction)
• are pregnant
• have developed ketosis previously
• are taking sodium-glucose co-transporter 2 (SGLT2) inhibitors (see information about SGLT2 inhibitors and DKA in Diabetic ketoacidosis associated with sodium-glucose co-transporter 2 inhibitors).

DKA should be considered if the patient develops abdominal pain, nausea, vomiting, fatigue or unexplained acidosis. A normal blood glucose concentration does not exclude DKA in a patient with type 2 diabetes, particularly in those taking an SGLT2 inhibitor; blood ketones should always be checked in a patient who is unwell.