Coronavirus can cause more severe symptoms and complications in people with diabetes. If patients become unwell or have a high fever, they should be asked to follow sick day rules advice. Diabetes UK has useful patient information as well as specific advice during the coronavirus pandemic.
SGLT-2 Inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin).
SGLT2- inhibitors should be temporarily stopped if patients become unwell, as it may predispose them to diabetic ketoacidosis (DKA) / Euglycaemic DKA.
See MHRA warnings of reports of DKA in patients taking SGLT-2 inhibitors, some fatal and presenting atypically, with only moderately increased blood glucose levels (< 14mmol/l).
Patients should be informed of the signs and symptoms of DKA and advised to seek medical advice if they develop any of these.
Blood ketone levels should be tested in patients with ketoacidosis symptoms, even if plasma glucose is near normal. SGLT-2 inhibitors should be discontinued immediately if DKA is suspected or diagnosed. DKA requires urgent hospital admission.
Blood ketone testing
Most people with type 1 diabetes should already have access to dual function meters and GP practices should ensure they have easy access to blood glucose and ketone test strips on repeat prescription.
For other patients who are acutely unwell, and who may need to test blood ketones, emergency supplies of dual function meters (GlucoMen Areo 2K and CareSens Dual) can be accessed from various locations across the city.
|If blood glucose is elevated, manage appropriately.|
|0.6 to <1.5 mmol/L may be at risk of DKA so test again after 2 hours||If the blood glucose is elevated manage appropriately. Recheck ketones in 2 hours. Ensure adequate fluid intake|
|1.5 to 3 mmol/L patient is at risk of DKA should contact their diabetes team or GP as soon as possible||Ensure adequate fluids. Retest blood glucose and ketones in 2 hours including during the night. Insulin patients can treat raised blood glucose by giving additional correction rapid acting insulin doses as per sick day rule advice.|
|>3mmol/L very high risk of DKA.
Needs urgent medical attention & may need admission to A&E
|Insulin patients need to treat raised blood glucose by giving additional correction rapid acting insulin doses. Ensure adequate fluids. If unable to keep fluids down or unable to bring glucose/ketone down, seek urgent medical advice.|
Medicines requiring extra care
There are several other classes of drugs that one should consider temporarily stopping during acute illness, see the SADMAN rules (take care when reducing or stopping diuretics in CCF). For patients who are not eating any food, consider if temporarily reducing or stopping their sulphonylurea is needed, though be aware that infections can raise glucose levels and medication may need to continue.
It is essential during significant illness, that patients who are taking sulphonylurea drugs can self- monitor at home.
We understand that practices may be receiving an increasing amount of sharps bins for disposal from patients. We also understand that some bins may be increasing in size and that storage of bins could also be an issue.
NHS England advise that practices can request extra collections, increased collection frequency or more/bigger bins within reason.
Please contact SRCL if you feel you need any of the above. The CCG will reimburse practices for any extra costs incurred.