People on insulin or an SGLT2 inhibitor are the ones in whom vomiting, poor intake or an acute illness can tip into ketoacidosis, including with near-normal glucose on an SGLT2 inhibitor. A thirty-second question at routine review closes the gap: what would you do with your tablets and insulin if you were vomiting or could not eat?
The usual advice is to pause the SGLT2 inhibitor during acute illness or fasting, never to stop basal insulin, to keep fluids going, to check ketones if unwell, and to seek care early. Make sure the patient and a family member can repeat it.
- Ask the sick-day question at review, not only when starting the drug.
- Pause SGLT2 inhibitors during vomiting, poor intake, fasting or acute illness.
- Continue basal insulin in insulin-treated patients and seek advice on dosing.
- Advise ketone testing and early review if unwell, even with a normal glucose.
- Write the plan down for the patient and a family member.
Why it matters
Sick-day counselling shouldn't disappear after the first prescription.
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