The Scandinavian register data give a short list worth asking at every refill, not only at initiation. Is HbA1c very high? Has the patient lost weight or is intake poor? Any previous ketoacidosis? Any recent hypoglycaemia, suggesting unstable insulin dosing? Is surgery or a procedure planned?
A yes does not mean stopping the drug. It means repeating sick-day rules, making sure the patient knows ketoacidosis can occur with near-normal glucose, and deciding whether ketone testing at home is sensible.
- Very high HbA1c, low BMI or malnutrition, previous ketoacidosis, recent hypoglycaemia, planned surgery.
- Pause the drug during vomiting, poor intake, infection with fever or heavy alcohol use.
- Warn that ketoacidosis can occur with glucose below 14 mmol/L.
- Hold before major surgery according to local perioperative guidance.
Why it matters
Sick-day counselling shouldn't disappear after the first prescription.
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