Sick Day Medication Dosing For Diabetes

During intercurrent illness, the risk of an adverse drug event could be increased by ongoing use of some medicines. They may cause harm with either continued use or abrupt cessation during illness. Factors to consider for dose adjustment include the type of medicine, formulation and pharmacokinetics, duration of illness and comorbidities.

Patients able to self-manage their diabetes medicines should be provided with a management plan for use during sick days. Patients who are not monitoring their own glucose should be advised to see their doctor when becoming ill.

An understanding of pharmacokinetic factors associated with significant illness (sick days) can be useful to predict and manage patients at most risk. Changes in drug absorption, distribution, metabolism and excretion are well documented in critically ill patients. Unfortunately, there are less data to guide the prescribing of regular medicines in less severe illness.

When the illness is short-lived and relatively minor, changes in physiology and pharmacokinetics are unlikely to be a problem for most medicines and in most patients. However, there are exceptions when patient advice about dose adjustment and monitoring for adverse outcomes may be necessary.

Patients able to self-manage their diabetes medicines should be provided with a management plan for use during sick days. Patients who are not monitoring their own glucose should be advised to see their doctor when becoming ill.