II. Management: General

  1. Diabetic action plan based on Blood Glucose Monitoring
  2. Early contact with medical provider when Glucose control acutely changes (see red flags listed below)

III. Management: Medications

  1. Metformin
    1. Stop when dehydrated (e.g. Vomiting, Diarrhea) and restart when resolves
  2. Insulin Secretagogues (Sulfonylureas, Repaglinide, Nateglinide)
    1. Hold for decreased intake and risk of Hypoglycemia
  3. Bolus Insulin (e.g. Regular, Lispro)
    1. Increase Bolus Insulin by 5-20% for consistent Blood Glucose >250 mg/dl
    2. Hold or decrease Bolus Insulin for inability to take carbohydrates and risk of Hypoglycemia
  4. Basal Insulin (e.g. Lantus, Detemir)
    1. Continue basal dosing despite illness
    2. Consider decreased basal Insulin Dosing if inability to eat carbohydrates
  5. Insulin Pump
    1. Make a back-up plan for Insulin Pump failure

IV. Management: Labs

  1. Glucose
    1. Seek medical attention (or call) for Blood Glucose consistently >300 mg/dl on at least 2 consecutive checks
    2. Increase monitor while ill
      1. No Insulin: 2-4 times daily
      2. Insulin: every 2-4 hours
  2. Ketones or Beta Hydroxybutyrate (in Type I Diabetes Mellitus)
    1. Home ketone monitoring while ill (especially with Blood Glucose >240 mg/dl)

V. Precuations: Red flags warranting repeat examination

  1. Prolonged Vomiting
  2. Inability to hold down fluids
  3. Presistent or Recurrent Hypoglcemia or Hyperglycemia

VI. References

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