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Sick-day rules in T1DM — MRCGP AKT MCQ

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EasyEndocrinologySick-day rules in T1DMMRCGP AKTUKMLAPARA

A 45-year-old man with newly diagnosed type 1 diabetes uses a basal–bolus insulin regimen. He asks what he should do if he develops an intercurrent illness with vomiting. Which advice should form part of his sick-day rules?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Continue long-acting insulin and monitor glucose and ketones

The correct answer is B. Long-acting basal insulin must be continued during intercurrent illness, even if the patient is vomiting or unable to eat. Illness commonly increases insulin requirements, and omitting basal insulin can rapidly cause ketogenesis and diabetic ketoacidosis. Blood glucose and blood or urine ketones should be checked more frequently, with additional rapid-acting insulin given according to the patient's individual sick-day plan. Fluids should be taken regularly; carbohydrate-containing fluids may be needed if normal food cannot be tolerated. Persistent vomiting, inability to retain fluids, or glucose or ketones that cannot be controlled requires urgent medical advice or emergency assessment. Doubling metformin is not a type 1 diabetes sick-day rule and may be unsafe during dehydrating illness.

Reference: My Way Diabetes NHS, Sick Day Guidance for Type 1 Diabetes, updated 6 January 2026. https://diabetesmyway.nhs.uk/resources/internal/sick-day-guidance-for-type-1-diabetes/