Non-diabetes illness

Hyperglycaemia (blood glucose greater than 9mmol/L) will adversely impact upon the outcome of any intercurrent illness – morbidity associated with any illness is 2-3 fold higher if blood glucose readings rise above this level.

Treatments aimed at controlling hyperglycaemia in acute illness need to be effective over the expected time-course of the illness (ie rarely will oral medication changes be effective).

The ONLY way to determine effective therapy during illness is to use blood glucose monitoring as a guide to titrate treatment. ALL patients known to be at risk of acute illness should be able to monitor in these circumstances even if monitoring is not part of their usual management strategy.

In patients previously not using insulin a safe short-term supplementation is to use a twice daily NPH insulin (such as Insulatard or Humulin I) at an initial dose of 8-10 units twice daily, up-titrated after 24-48 hours if hyperglycaemia persists and discontinued when blood glucose readings are reliably below 10mmol/L.

For patients previously using insulin see 'Managing fluctuating illness' and 'Type 1 and Type 2 sick day rules' for dose titration advice during illness.