Sick Day Management of T2DM

For non-insulin-treated type 2 diabetes during intercurrent illness, monitor blood glucose more frequently and seek medical assistance if two consecutive readings are above 15 mmol/L. See also the emergency red flags on the Type 2 Diabetes Management page and the DKA & HHS page.

Medication adjustments during acute illness:

• Metformin — may need to be withheld if dehydrated from vomiting/diarrhoea, especially with pre-existing renal impairment (reduced clearance → risk of lactic acidosis).
• SGLT2 inhibitors — withhold while acutely unwell (risk of DKA, including euglycaemic DKA, and dehydration); restart when eating and drinking normally.
• GLP-1 receptor agonists — withhold with nausea/vomiting/diarrhoea, as symptoms can be worsened.
• Sulfonylureas — withhold if hypoglycaemic or trending toward hypoglycaemia.
• DPP-4 inhibitors — generally safe to continue.