Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-47

2. Sick-day management Health-care providers should routinely review sick-day guidance and assess knowledge and self-management with all individuals. When a person becomes ill and is unable to maintain adequate fluid intake, they are at risk of dehydration. This “Ill”state: • increases the risk of hyperglycemia due to catecholamine release of counter regulatory stress hormones • increases the risk of diabetic ketoacidosis due to electrolyte imbalances and an enlarged gap between high glucagon (ie. counter-regulatory hormone response during sickness) and lowered insulin levels, particularly exacerbated in the presence of ketones • increases the risk of acute kidney injury due to dehydration and electrolyte disturbances • in the event the person is taking medications associated with hypoglycemia, the person can be at increased risk of hypoglycemia if they are unable to maintain/replenish carbohydrate consumption Therefore, in the “ill” state, when the person is at risk of dehydration and where the person cannot adequately replenish fluids, to minimize the risk of acute kidney injury, it is recommended the following medications be temporarily stopped until adequate fluid consumption resumes and/or symptoms resolve: • S ulfonylureas • A CE inhibitors (angiotensin-converting enzymes) • D iuretics • M etformin • A RBs (angiotensin II receptor blockers) • N SAIDs (non-steroidal anti-inflammatory drugs) • S GLT2i Similarly, in the “ill” state, if the person is taking medications associated with hypoglycemia, if the “ill” state results in vomiting and/or the inability to adequately consume carbohydrates, the person could be at risk of hypoglycemia. This risk of hypoglycemia is offset by the concurrent increase in counter-regulatory stress hormone release, the body’s natural response to “illness”. It is recommended in these situations, where possible, the person with type 2 diabetes checks their blood glucose a minimum of every 4 to 6 hours, The person should be directed to contact their health-care team if they feel they cannot cope or if their sugars remain above/below target despite the person’s actions to bring sugars to within the individualized target range. (79). During periods of “illness” (with vomiting / diarrhea), when a person cannot adequately consume/replenish their normal carbohydrate intake, may be considered to be temporarily stopped until adequate carbohydrate intake consumption resumes and/or symptoms resolve.