Problem solving in type 1 diabetes for primary care nurses– part 2

What actions should individuals with type 1 diabetes (T1DM) take in situations of acute illness?

Commonly blood glucose readings will rise during intercurrent illness even if the individual is not eating. This situation will require increased insulin dosage, typically using a rapid-acting insulin (or a mixed biphasic insulin if this regime is being used) to administer correction doses based on insulin sensitivity factor (see part 1). If ketosis is present advise patients to increase fluid intake to counter dehydration, along with insulin correction doses (every 2 hours if necessary) and maintenance of simple carbohydrate diet. If persistent vomiting prevents fluid absorption, or if blood glucose levels cannot be controlled, or if ketone levels rise (see part 1) then medical advice should be sought urgently with a view to hospital admission. Key responses are outlined in table 1.^1,2 Individuals also need to be aware that certain classes of medication should be temporarily stopped in acute illness to reduce the risk of dehydration and acute kidney injury. In the case of metformin there is a risk of lactic acidosis and SGLT-2 inhibitors increase the risk of diabetic ketoacidosis, although neither is routinely used in T1DM. The medications implicated are listed below and can be remembered by the mnemonic SADMAN.