Instructions

Sick-Days and Oral Meds: To Hold or Not To Hold?

It is important to have a clear plan with patients on when to hold oral medications on sick days.

This plan should be established when the medication is started, and reviewed at each patient encounter.

In deciding whether to stop a diabetes medications we should consider the individual’s risks and needs.

Is the risk of medication side effect higher than risk of temporary hyperglycemia?

Is there a temporary way to manage blood sugars without the medication (short term long acting insulin)

Will the experience of illness or side effects cause the patient to have a negative association with this therapy in the future?

Would it be appropriate to set different sick-day glycemic goals vs well days? (higher targets to avoid hypos or lower targets to focus on healing)?

Metformin – increased risk of GI s/e

Increased risk of lactic acidosis

SGLT2 – STICH protocols (we'll talk about these in a moment)

Increased UTI risks – consider stopping when treating UTI, vaginosis, yeast or bladder infection.

Sodium–glucose cotransporter 2 inhibitors, approved for treatment of type 2 diabetes, have been found to increase the risk of

DKA. In May 2015, the U.S. Food and Drug Administration issued a drug safety communication about this risk (24) and

subsequently added a warning to the drug label.

GLP1 – increased GI s/e

-increased hypoglycemia risk

Sulfonylureas – increased hypoglycemia risk

Renal clearance concerns with dehydration – remember the DAAMN G’S!

Diuretics,

Ace inhibitors,

ARBs

Metformin

NSAIDs

GLP1s

SGLT2 i

Consider the impacts of changes in absorption or clearance of non-diabetes meds such as: pain medications, antidepressants, controlled release medications, etc.

And let's talk about the STICH protocol. It is a handy way for you and your patients to remember this strategy for patients on SGLT2 medications. I recommend printing these as small reminder cards for people on SGLT2 medications and encouraging them to tape them where they keep their OTC medications so they remember the info on sick days.