Type 2 diabetes sick days: should I stop metformin or other tablets during fever?
Patient's Query
I have type 2 diabetes and I take metformin daily, and sometimes another tablet also. Now I have fever and body pains, and I am not eating properly. I am mostly on liquids and sometimes fasting because I feel nauseated.
My family says I should stop all diabetes medicines until I recover, otherwise my sugar may go too low. But I am also worried that if I stop medicines, my sugar may go too high.
What should I do during a sick day? Should I skip metformin when I have fever or when I’m not eating? How do I monitor sugars at home, and when should I go to the hospital?
Endocrinologist Answers
In type 2 diabetes, sick days need a bit of planning. The main idea is simple.
Illness often raises sugar, even if you are eating less.
Fever and infection increase stress hormones, and sugars can shoot up. So stopping all medicines blindly is not safe.
But at the same time, some tablets should be paused in certain sick-day situations, mainly to avoid dehydration-related side effects.
Here is a practical sick-day approach.
Monitor more often
- Check sugar every 4 to 6 hours while you are unwell
- Drink fluids regularly. Do not allow dehydration
Metformin(when to continue, when to pause)
If you have a mild illness and you are drinking fluids and eating something, metformin is usually continued.
Stop metformin temporarily if you have:
- Persistent vomiting or diarrhea.
- Dehydration.
- Severe weakness, low blood pressure, or breathlessness.
- Hospitalization, severe infection, or reduced kidney function. This is to reduce the rare risk of lactic acidosis in high-risk settings.
A simple rule for patients is:
If you cannot keep fluids down or you are dehydrated, pause metformin and call your doctor.
Other common tablets that may need sick-day pauses
Your doctor may advise holding some drugs during dehydration or poor intake, such as:
- SGLT2 inhibitors during acute illness or fasting because they can increase risk of dehydration and ketones
- Sulfonylureas if you are eating very little, because they can cause low sugar
This is why we do not give one fixed rule for everyone.
What about insulin
Many type 2 patients do not use insulin, but if you are on insulin, do not stop it without medical advice. Doses may need adjustment based on sugars.
Practical example:
If you have fever, eating is less, but sugar is 280 to 320 mg/dL repeatedly. This is not the time to stop everything. You need monitoring, hydration, and your doctor may adjust treatment temporarily, sometimes even add short-term insulin.
Go to hospital urgently if
- Sugars stay above 300 mg/dL repeatedly despite fluids and medicines
- You have vomiting, dehydration, fast breathing, severe drowsiness, chest pain
- You have signs of very low sugar like confusion, fainting
- You are a kidney patient and feel unusually weak or breathless
Final advice
Sick-day medicine decisions are individualized. Do not stop or restart tablets based on family advice or internet lists.
If you are sick enough to be fasting or vomiting, call your physician or endocrinologist the same day and follow a clear plan.
References:
- https://diabetesjournals.org/care/issue/49/Supplement_1/
- https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2020/04/3.-Covid-19-Type-2-Sick-Day-Rules-Crib-Sheet-06042020.pdf
- https://kdigo.org/wp-content/uploads/2020/10/KDIGO-EASD-EMJ-Diabetes-8.1-2020-1.pdf
- https://www.diabetes.org.uk/living-with-diabetes/life-with-diabetes/illness
Disclaimer: The information provided in this Q&A is for educational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized medical guidance and treatment recommendations.