When to stop non-insulin diabetes medications

DPP4 inhibitors "-gliptins"

  • Given any time of day
  • Check BNF - some require dose reduction in acute kidney injury
  • Withhold if vomiting

 

Sulphonylureas (gliclazide most common)

  • Given at mealtimes
  • Withhold or reduce dose if:
    • hypoglycaemia
    • reduced oral intake
    • acute kidney injury

 

GLP-1 analogues "-glutides"

  • Given once weekly SC (dulaglutide, semaglutide) or once daily SC (liraglutide) or once daily oral (semaglutide)
  • Withhold if:
    • vomiting or diarrhoea
    • pancreatitis (and discuss with diabetes before restarting)

** Please note there is a global shortage of GLP-1 agonist medication until mid 2024 **

If a patient brings in their own supply, these can be given but it is possible the hospital will struggle to supply these medications in the longer term

An alternative medication may need to be considered if control is poor  

 

Metformin

  • Given at mealtimes
  • Renal function:
    • stop if eGFR <30
    • max dose 1g daily if eGFR 30-45
  • Withhold if:
    • increased lactate
    • sepsis
    • vomiting or diarrhoea

 

Pioglitazone

  • Given any time of day
  • Stop and discuss with diabetes team if:
    • fluid overload
    • deranged LFTs
    • new fracture
    • bladder cancer

 

SGLT2 inhibitors "-gliflozins"

  • Given any time of day
  • Consider euglycaemic DKA in any unwell patient on SGLT2i
    • check capillary ketones and VBG
    • don't restart after euglycaemic DKA unless advised by diabetes
  • Withhold if:
    • significant acute illness
    • reduced oral intake or fasting
    • vomiting or diarrhoea
    • infection
    • acute kidney injury (or adjust dose)

 

When should I call the diabetes team?

  • If capillary blood glucose consistently >12mmol/l when withholding medication
  • In hours, if unsure whether to stop a medication (if out of hours, withhold until you can discuss)
  • Remember to consider restarting medications on discharge