“Are there any medications I should stop if I’m sick?”

Yes, there are. It’s important to know your medications – names, dosage, why you take them, any potential side effects and of course, which ones to cease temporarily and contact your GP if you’re unwell.

This is the time to check your BG levels more frequently, aiming to keep them all under 12mmols.  Over 15mmols you can become quite dehydrated.  Everyone with diabetes should have a Sick Day Management Kit and Sick Day Management Plan personalised to them for times of illness.

Are you on any of these? You may be on more than one or a combination.

BIGUANIDES: Metformin is the active ingredient.  Common brand names Diabex® Diaformin® Metex® Glucophage® Formet® Metformin® Diabex XR® Diaformin XR® Metex XR®.

In combination with DPP4i – Janumet® Tragentamet® Galvumet® Nesina Met® Kombiglyze®.

In combination with SGLT2i – Jardiamet® Xigduo®

Temporarily cease and seek medical advice if: Unwell and not able to eat, and tablet is causing nausea or difficult to swallow, kidney function less than 30% (eGFR 30 on blood test).

DPP-4 inhibitors: Brand names Januvia® Trajenta® Onglyza® Galvus® Nesina®.

In combination with Metformin® – Janumet® Galvumet® Trajentamet® Nesina Met® Kombiglyze®.

In combination with SGLT2i – Glyxambi®

Temporarily cease and seek medical advice if: Persistent or severe abdominal pain and see your GP, as risk of pancreatitis.

SGLT2 inhibitors: Brand names – Jardiance® Forxiga®.

In combination with Metformin® – Xigduo® Jardiamet®.

Temporarily cease and seek medical advice if you experience these symptoms of DKA (diabetic ketoacidosis), which is a very serious condition. You’re at risk of developing DKA on this medication, even with normal or mildly elevated BG levels (unlike DKA in type 1 diabetes where BG levels are significantly elevated).

Signs and symptoms of DKA – Extreme thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity breath smell, confusion.

One theory why this may occur with this medication is that SGLT2 inhibitors decrease the production of insulin when your body is under stress.  With insufficient insulin working, glucose can’t be used for energy, so your body needs an alternate fuel source – fat.  This results in high levels of acid bodies called ketones. There are 3 meters in Australia specifically designed to check for blood ketones – Freestyle Optium, Freestyle Libre, and the Glucokey.  They need specific ketone testing strips, different to your glucose testing strips.

NB. Cease if severe pain, tenderness, redness, or swelling in your genital area, accompanied by fever or fatigue and see your GP immediately. This is a rare infection, but important for you to be aware of.

Ask your GP when you can recommence this medication again.  Usually it’s when you’re eating and drinking normally and feeling well again.

SULPHONYLUREASCommon brands names – Diamicron®, Glyade®, Amaryl®.

Combined with Metformin® – Glucovance®

Temporarily cease and seek medical advice if: you’re unwell and aren’t able to eat enough to prevent hypoglycaemia.

GLP1 AGONIST (Injectable): Brand names – Byetta® Victoza® Bydureon® Trulicity®

Seek medical advice if: you’re also on insulin or a Sulphonlyurea and aren’t able to eat as much carbohydrate as usual.  You may need to decrease your insulin dose or temporarily cease your GLP1 injection to prevent hypoglycaemia.

Cease immediately and seek medical advice if you have persistent or severe abdominal pain due to risk of pancreatitis.

If you need more information about your diabetes medications speak with your Pharmacist, GP or Diabetes Educator.

There’s a lot to know about your diabetes medication.  We trust this information helps you during this time.  Keep learning and asking questions.  You need to be the driver of your diabetes.  Let us know any other questions you have about medications on our Facebook page or send us a question on the Contact Us page of our website drivingdiabetes.com.au.

Amanda & Helen

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