Specific advice for diabetic patients unwell with Covid-19
This information is sourced from Diabetes UK, a Primary Care Diabetes Society (PCDS) factsheet and PCDS update:
Key points:
- There is an increased risk of metabolic decompensation in people with diabetes during Covid-19 infection
- Capillary glucose and urinary ketone levels should be checked in people acutely unwell with suspected Covid-19
- Advise patients how to follow the SICK rules for managing intercurrent illness
- Insulin therapy should never be stopped during intercurrent illness
- Patients should stop taking SGLT2i tablets if they become unwell with Covid-19 because of the increased risk of DKA
- Metformin may warrant temporary suspension during the acute illness phase
- Oral therapies can usually be re-started once the acute phase has passed and the individual is eating and drinking again
- Consider supporting people with diabetes with home oximetry even if <65 yrs and not CEV
- Be aware of the risk of euglycemic DKA during acute intercurrent illness in people prescribed SGLT2 inhibitors, even in the presence of relatively normal blood glucose levels
- Some people with diabetes may be discharged from hospital on higher doses or additional glucose-lowering therapies, including insulin, that may need adjustment in subsequent days or weeks
Useful resources:
- There is a very clear algorithm on the PCDS factsheet for managing dosing of rapid-acting insulin
- Diabetes UK provide helpful information for patients on how to identify and manage hyperglycaemia and hypoglycaemia
