Diabetes - sick day management

Date Published: 
Tuesday, May 3, 2022

In this episdoes Ryan Paul discusses sick day management in the patient with diabetes.



  • 00:01 Intro
  • 01:12 Should all patients with diabetes have a sick day plan?
  • 01:34 What's a sick day plan look like?
  • 02:12 What sort of monitoring should we be telling our unwell diabetic patients to do
  • 05:04 At what point should we consider admission to hospital?
  • 06:03 different classes of medications - What medications may need to be altered or stopped?
  • 06:11 Sulphonylureas
  • 07:45 Metformin
  • 08:21 Sglt2 inhibitors
  • 10:53 Diabetic ketoacidosis
  • 12:08 Differentiating one from the other
  • 13:08 What a patient should expect on admission to hospital
  • 14:13 Restarting medications
  • 15:05 Type 2 diabetic patients and COVID
  • 16:29 Dexamethasone
  • 18:19 Managing dexamethasone patients in the community
  • 19:31 Take-home messages


Take-home messages

  • All patients with diabetes should have a sick day management plan
  • Regular monitoring of glucose levels is vital in the unwell patient with diabetes
  • SGLT2i need to be stopped when unwell to prevent diabetic ketoacidosis
  • Other glucose lowering agents may also need to be stopped depending on the illness
  • Proactive escalation of therapy is often required to prevent significant steroid-induced hyperglycaemia  risk




Ryan Paul

Ryan is a Diabetologist at the Waikato District Health Board and a Senior Lecturer at the University of Waikato. Particular research interests include the use of emerging technologies in type 1 diabetes, the management of diabetes in youth and young adults, reducing inequities in diabetes care in Māori and rural populations, and improving models of diabetes care. Ryan has just stepped down as the President of the New Zealand Society of Endocrinology (NZSE) and is an Executive Member of the New Zealand Society for the Study of Diabetes (NZSSD). Ryan is a Clinical Associate of the Maurice Wilkins Centre and was awarded the New Zealand Clinical Educator of the Year by the New Zealand Medical Council in 2019.


This episode is supported by an educational grant from Lilly.

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This presentation is intended for qualified health practitioners professional development and should not be relied upon for any other purpose. Any opinions offered are those of the presenter or other speaker and do not necessarily represent the views of Goodfellow Unit.