6.2 Outline how treatment for diabetes may be required to change in response to intercurrent illness

This guide will help you answer 6.2 Outline how treatment for diabetes may be required to change in response to intercurrent illness.

Diabetes is a long-term condition that affects blood glucose levels. People with diabetes need to carefully manage their blood sugar each day. When someone with diabetes develops an intercurrent illness the balance of blood glucose can become more difficult. An intercurrent illness is any additional short-term condition or infection that comes up while someone is living with diabetes. Common examples include flu, a cold, chest infection, urinary tract infection, vomiting or diarrhoea, and even minor infections such as a tooth abscess.

These illnesses can put extra strain on the body. Even a minor illness can affect the body’s normal response to insulin and medication. The risk of very high or very low blood sugar rises when the body is unwell, so it is important for both the person and their support team to recognise the need for changes in diabetes treatment during this time.

How Intercurrent Illness Affects Blood Glucose

When someone with diabetes is unwell, physical stress and infection cause the body to release stress hormones, such as cortisol and adrenaline. These hormones make it harder for insulin to work and cause the liver to release more glucose into the blood. This often leads to higher than expected blood sugar readings. In some illnesses, especially vomiting or diarrhoea, blood sugar may drop too low if food cannot be kept down.

This means that treatment plans that work on ‘normal’ days often do not work in the same way when a person is ill.

Key points:

• Stress hormones make blood sugar control more difficult during illness
• Blood sugars can rise or fall depending on the illness and ability to eat
• Normal routines, such as medication and meals, may be disturbed

Why Treatment Changes May Be Needed

During an intercurrent illness, diabetes management often has to change to keep the person safe.

Main reasons for change:

• Illness can increase insulin needs, even if a person is eating less
• Some illnesses stop a person from eating, which increases the risk of low blood sugar
• Symptoms like vomiting, diarrhoea, and fever can lead to dehydration, which is dangerous for anyone but especially people with diabetes

If the person does not adjust their diabetes treatment, they risk both short- and long-term problems such as diabetic ketoacidosis (DKA), hypoglycaemia, or hyperosmolar hyperglycaemic state (HHS).

General Principles for Managing Diabetes During an Illness

When a person with diabetes becomes unwell, their treatment plan should be reviewed and adjusted.

Key steps include:

• Checking blood sugar more often, sometimes every two to four hours
• Continuing to take diabetes medication unless a health professional advises otherwise
• Adjusting medication doses, especially insulin, based on blood sugar readings
• Keeping hydrated with sugar-free fluids
• Eating small amounts regularly, even if appetite is poor

This approach can help reduce the risk of complications.

Monitoring Blood Glucose and Ketones

Frequent monitoring of blood sugar is vital during illness. Blood sugar can swing much more than usual, so sticking to normal routines or usual testing patterns can put health at risk.

Key points about monitoring:

• Test blood sugar more often: usually every two to four hours, including overnight
• Watch for high blood sugars (hyperglycaemia): these can need extra doses of insulin
• Watch for low blood sugars (hypoglycaemia): this can happen if the person cannot eat
• For people who take insulin, check for ketones in the blood or urine if blood sugar is very high or if vomiting occurs
• Keep a record of readings for health professionals

If ketones (acidic chemicals produced when the body burns fat for fuel, often during insulin shortages) are found, urgent medical review is needed. This can signal diabetic ketoacidosis, which can be life-threatening.

Changing Medication and Insulin Doses

One of the most common changes during illness is an adjustment in diabetes medication, especially insulin. Illness usually increases the body’s need for insulin.

Points to consider when changing doses include:

• People who use insulin may need higher doses than usual, sometimes up to 25 to 50 percent more
• Extra ‘correction’ doses of insulin may be required to bring blood sugar down if levels stay high
• Tablets such as metformin or sulphonylureas are usually continued, but may need to be paused temporarily if vomiting or severe dehydration occurs (health advice should be sought)
• Some medications, such as SGLT2 inhibitors, should be stopped during illness, particularly when there is vomiting or risk of dehydration

Insulin should not be stopped during illness unless a doctor advises it. Stopping insulin can lead to dangerous blood sugar levels and the risk of ketoacidosis.

Managing Food and Fluid Intake During Illness

Illness often affects appetite. Vomiting, nausea, and diarrhoea make it difficult to eat and drink normally. It is important to avoid both dehydration and low blood sugar.

Suggestions include:

• Sip small amounts of sugar-free fluids regularly: aim for at least 100ml every hour (about half a teacup)
• If unable to eat usual meals, try to eat or drink foods and fluids containing carbohydrate, such as soup, milk, ice cream, or juice
• For people at risk of low blood sugar, keep glucose tablets or sugary drinks to hand in case of hypoglycaemia
• If unable to keep foods or fluids down, medical advice is needed, especially for people who take insulin, as serious complications can develop quickly

Sick Day Rules for Diabetes

Most diabetes care teams provide ‘sick day rules’ for times of illness. These are simple steps to follow to prevent problems and keep blood sugar under control.

Main elements of sick day rules:

• Never stop taking insulin: dose may need to go up or down but should not be missed
• Test blood sugar more regularly
• Check ketones if feeling unwell or if blood sugar is high (usually over 15mmol/L)
• Keep drinking fluids even if unable to eat usual meals
• Contact the diabetes team or GP if:
  • Blood sugar stays high (over 15mmol/L)
  • There are moderate or high ketones
  • Vomiting continues for more than a few hours
  • There are signs of dehydration

These rules help the person and caregivers know when to increase monitoring or call for help.

Recognising and Preventing Complications

There is a higher chance of complications during illness for people with diabetes. The two most concerning problems are:

1. Diabetic Ketoacidosis (DKA):
This happens mostly to people with type 1 diabetes and is triggered by lack of insulin. Fat is used for energy, producing acidic ketones which lead to dehydration and a dangerous rise in blood acids.

Early signs:

• High blood sugar
• Ketones in blood or urine
• Nausea, vomiting, abdominal pain
• Rapid breathing, confusion

2. Hyperosmolar Hyperglycaemic State (HHS):
This mostly affects people with type 2 diabetes and happens during prolonged high blood sugar and severe dehydration.

Early signs:

• Extremely high blood sugar (sometimes over 30mmol/L)
• Confusion, drowsiness
• Very concentrated urine, little urine output
• Rapid breathing

Both are medical emergencies. Quick action and changes in treatment, including extra insulin and fluids, can save lives.

When to Seek Medical Help

Not every illness can be safely managed at home. It is important to ask for help from the GP, diabetes nurse, or NHS 111 if:

• The person cannot eat or drink and is becoming weaker
• Vomiting or diarrhoea lasts more than a few hours
• Blood sugar remains high after extra insulin doses
• Ketones are present in the urine or blood
• The person becomes confused, very sleepy, or is struggling to breathe

Support workers should encourage the person to keep their sick day information close, and know who to call for help.

Supporting People with Diabetes During Intercurrent Illness

Support from care staff can make a big difference to the outcome during a period of illness.

Ways to help:

• Encourage regular blood sugar checks and help record the results
• Help the person to take their medication correctly and at the right times
• Prepare suitable foods and offer fluids often
• Watch for changes in behaviour or warning signs of complications
• Support the person in contacting their nurse or GP if needed
• Listen to the person’s concerns: illness can be stressful and frightening

Any worker supporting a person with diabetes should know the basics of sick day rules and the main warning signs that mean urgent help is needed.

Adjustments for Different Types of Diabetes

People manage diabetes in different ways and the changes needed during illness depend on their usual treatment.

• People with Type 1 diabetes: Always need extra care, as insulin is essential for survival. Danger of DKA and insulin must always be continued
• People with Type 2 diabetes on tablets: Often need to continue usual doses, but some tablets are paused if unwell. Blood sugar still needs to be checked more often
• People with Type 2 diabetes on insulin: May need higher insulin doses during an illness, with more careful monitoring for low or high blood sugar
• People using insulin pumps: Extra attention needed, as pump sites can stop working during illness and ketones can rise quickly

Care support should always be based on the advice given by the diabetes team or the person’s own sick day plan.

Role of Health and Social Care Workers

Workers play a key role during periods of illness by:

• Reducing anxiety, helping the person feel safe
• Spotting early signs that blood sugar is out of control
• Making changes promptly, such as helping with drinks, meals, or medication
• Recording all observations accurately
• Monitoring for side effects of medicines or signs of complications
• Working with other professionals to keep the person well
• Respecting the person’s right to make choices about their own care

A well-informed worker can pick up subtle signs that would be lost in a busy setting, and help prevent emergency hospital admission.

Diabetes and Other Medications

When someone with diabetes is ill, other prescribed or over-the-counter medications may affect their glucose control.

Examples include:

• Steroids: Often increase blood sugar
• Antibiotics: Used for infections, can sometimes cause stomach upset or affect blood sugar indirectly
• Painkillers: Some contain sugar, which may affect readings
• Antiemetics (drugs for sickness): Can be needed so that food or drink can be kept down

It is important to tell the GP or pharmacist if a person with diabetes needs any new medicines during illness.

Care Planning and Communication

A good support plan for someone with diabetes will include specific instructions for managing illness. This plan should be kept up to date and reviewed after any illness episode.

Features include:

• Contact numbers for diabetes professionals
• Clear guidance on sick day rules
• How to record blood sugar and ketone monitoring results
• Steps for recognising when help is needed
• Instructions about medication changes during illness
• Space for workers to record observations and actions taken

Good communication within the team makes sure that everyone knows what action to take if the person becomes unwell.

Final Thoughts

Managing diabetes during an intercurrent illness needs flexibility, attention, and good teamwork. The approach is always based on the individual’s needs, with the aim of preventing complications and making sure the person feels cared for and safe.

Care workers have a responsibility to notice changes, listen to the person, and act quickly when blood sugar control is disrupted by illness. By encouraging self-care, following sick day rules, and knowing when to call for help, you play a vital part in keeping people healthy and comfortable during times of illness.

Staying up to date with guidelines provided by healthcare professionals, and supporting the person to communicate their needs, helps avoid serious problems and supports recovery. Frequent, kind reminders and practical help can make illness less frightening and help people with diabetes feel much more in control.