Part 2: Sick days
Imran has a stomach bug and hasn't eaten all day. His plan is to skip every tablet. Saima isn't so sure.
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Two days after Eid, Imran has a stomach bug. He has been vomiting since the morning and hasn't kept anything down.
“You haven't eaten all day. What about your tablets?”
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“No food, no medicine. That's simple.”
When you are ill, the body releases stress hormones that raise glucose, even if you are eating less. Vomiting and diarrhoea also dehydrate you, and some medicines become risky when you are dehydrated.
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“Metformin, your sugar tablet, the blood pressure one… Do we stop them all?”
What should they do about his medicines?
Tap an answer to see what happens.
AStop every medicine until he can eat.
What happens instead
Insulin and sulphonylureas are different: they are held only if your sugar is low.
“So stopping everything isn't the rule. Let's not guess.”
BCarry on with everything as usual.
What happens instead
When you are vomiting, have diarrhoea or can't keep fluids down, some medicines can harm the kidneys or drop your blood pressure too far.
COpen his sick-day list: pause some, keep others, and ask the clinic.
✓ The right step
“Dr. Sahib gave us a list for exactly this. It's with your prescription.”
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“While you're vomiting or can't keep fluids down, pause these until you're eating and drinking normally:”
- metformin
- SGLT2 inhibitors such as empagliflozin and dapagliflozin
- blood pressure tablets of the ACE-inhibitor and ARB kind, such as ramipril and losartan
- water tablets
- painkillers such as ibuprofen and diclofenac
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Restart them within 24 to 48 hours of feeling better.
“Your sugar tablet is different.”
Insulin and sulphonylureas are different: they are held only if your sugar is low. Agree your own list with your doctor before you need it, and keep it with your prescription.
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Check your glucose at least every four hours while you are ill.
“Ten o'clock: 210. I've set alarms for two and six.”
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“Juice? I thought juice was forbidden.”
“Not today. Today it keeps your sugar from falling.”
Drink plenty of unsweetened fluids, such as water and thin soup, a little at a time and often.
If you can't eat, take some carbohydrate as a drink instead: sip juice or a regular cold drink, so your body still gets sugar — especially if you take insulin or a sulphonylurea.
On the back of the list, Dr. Sahib had written one more thing. Go to hospital if…
- you can't keep fluids down;
- ketones are above 3.0 mmol/L, or 2+ or more on a urine strip;
- you are breathing fast and deep, have stomach pain, or your breath smells fruity;
- you are drowsy or confused;
- you have a fever with a racing heart, or feel faint when you stand.
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Call Rescue 1122 rather than driving yourself.
By the next evening he keeps soup down, and the vomiting has stopped.
“So next time I'm ill, I open the list first.”
“And you don't decide on your own.”
What to remember
- Check your glucose at least every four hours while you are ill.
- If you take insulin, don't stop it, even if you can't eat.
- While you can't keep fluids down, pause metformin, SGLT2 inhibitors, ACE-inhibitor and ARB blood pressure tablets, water tablets and painkillers such as ibuprofen. Restart them within 24 to 48 hours of feeling better.
- If you can't eat, sip juice or a regular cold drink so your body still gets sugar.
- Call Rescue 1122 rather than driving yourself.