Table of Contents:

1. Sick Day Management for Type 2 Diabetes
2. When should I call my health care provider?
3. Medication Use During Sick Days with Type 2 Diabetes
4. Medications used to treat hypertension
5. Other Medications
6. Additional Information & References

1. Sick Day Management for Type 2 Diabetes

There is no evidence currently that children and youth with type 2 diabetes have a higher chance getting COVID-19, or that they can have a more severe disease.

Type 2 diabetes in children and youth require special attention when it comes to sick day management. For diabetes management, some patients use oral medications that can lower the blood glucose alone or in combination with insulin. Patients may also be using medications to control their blood pressure or protein in the urine.

In our view, to manage diabetes safely during an illness, patients and families should do the following:

1. Contact the Diabetes Healthcare Provider if there are questions about diabetes management with or without illness.
2. Insulin should be taken but dose adjustments may be needed. It is a good idea to discuss the plan with your health care team in advance.
3. Check your blood glucose every around 4 hours, 24 hours a day. Keep accurate records.
4. If indicated by the diabetes team, check ketones every time you urinate or every 4 hours if using blood ketone testing.
5. Drink plenty of fluids and eat well-tolerated foods. Aim for 1 cup (8 ounces) of calorie-free fluids every 2-3 hours while awake to prevent dehydration.
6. Be careful with over-the-counter medicines. If considering the use of a cold remedy or cough syrup, ask the pharmacist to help with making a good choice. Since many cold remedies and cough syrups contain sugar, try to pick a sugar-free product.

2. When Should I Call my Health Care Provider?

When you have diabetes, sick days often involve more than just dealing with a runny nose and sneezing. Conditions that result in nausea, vomiting, or diarrhea can increase or decrease the blood glucose levels and may lead to dehydration. Again, it’s important to test the blood glucose levels when sick.

Call the Diabetes Health Care Provider if:

• The blood glucose stays higher than 14.0 mmol/L for two consecutive readings and does not respond to increased insulin (for those on insulin) and fluids
• Your blood glucose stays lower than 4.0 mmol/L for two consecutive readings and does not respond to hypoglycemia treatment
• You have a fever (temperature over 38.3 degrees Celsius)
• You have diarrhea or vomiting twice or more in 4 hours
• You have difficulty breathing
• You have moderate to large ketones and taking extra insulin and hydrating does not improve them
• You are unsure how much insulin/medication to take

It is important to be prepared. Having a “sick day” kit that includes a thermometer, sugar-free cough medicine/cough drops. Depending on the local setting, having important phone numbers for the diabetes healthcare team, family doctor, local emergency department, and insurer is a good idea.

3. Medication Use During Sick Days with Type 2 Diabetes

Metformin

For children and youth taking Glucophage^® (metformin) or Glumetza^® (once-daily metformin), if the patient is able to drink enough fluids and stay well hydrated, then the use of metformin may continue.

However, illnesses that can cause dehydration, especially with vomiting or diarrhea, can cause challenges. Always check that the patient is passing normal amounts of urine with illness, as this mean they are probably well-hydrated.

If a patient becomes sick and is unable to drink enough fluids to keep hydrated then STOP metformin, and contact the diabetes healthcare provider for suggestions. Re-start metformin once recovered.

4. Medications used to treat hypertension

Some children and youth with type 2 diabetes are on medications to treat high blood pressure and protein in the urine (proteinuria).

Blood pressure medications that children and youth with type 2 diabetes may be taking include:

A-Angiotensin-Converting Enzyme Inhibitors (ACEI) e.g. Capoten (captopril), Vasotec (enalapril), and Altace (ramipril), Zestril (Lisinopril) , Monopril (Fosinopril)

B-Angiotensin receptor blockers (ARB) e.g. Candesartan (Atacand), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan)

If the patient is sick, it is better to hold-off on giving these medications to avoid the blood pressure going too low as this may lead to acute kidney injury.

5. Other medications

Other medications that children and youth with type 2 diabetes may take during an illness include non-steroidal anti-inflammatory drugs e.g. Aspirin/ASA, ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac (Voltaren).

These medications are commonly used to deal with symptoms of viral infections such as fever, including COVID-19. Please check with the pharmacist before using over-the-counter medications and discuss all changes in medications with your health care provider.

If the patient is unable to maintain hydration at home, then contact the healthcare provider to discuss further options. There may be a need to attend the emergency department if the patient dehydrated and is unable to drink to replace the fluid losses.

6. Additional Information & References:

1. Diabetes Canada
2. American Diabetes Association

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