How is intercurrent medical illness in type 2 diabetes mellitus (DM) managed?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Patients with intercurrent illness become more insulin resistant because of the effects of increased counterregulatory (ie, anti-insulin) hormones. Therefore, despite decreased nutritional intake, glycemia may worsen.

Patients on oral agents may need transient therapy with insulin to achieve adequate glycemic control. In patients who require insulin, scheduled doses of insulin, as opposed to sliding scale insulin, are far more effective in achieving glycemic control. [312, 313]

Metformin is a special case. If patients taking metformin have any illness that leads to dehydration or hypoperfusion, the drug should be temporarily discontinued because of a possible increased risk of lactic acidosis.


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