How should I adjust the management plan for a patient with type 2 diabetes who presents with acute hyperglycaemia?

Adjusting the management plan for a patient with type 2 diabetes presenting with acute hyperglycaemia involves the following steps:

• Assess symptoms and severity: If the patient is symptomatically hyperglycaemic, consider initiating immediate insulin therapy or treatment with a sulfonylurea, guided by specialist advice, and plan to review treatment once blood glucose control is achieved.
• Review and reinforce lifestyle measures: Emphasize the importance of diet, exercise, and adherence to medication as part of the management plan.
• Self-monitoring of blood glucose: Advise increased blood glucose self-monitoring during the acute illness, especially if the patient is on insulin, but routine self-monitoring is not generally recommended for all type 2 diabetes patients unless specific indications exist.
• Do not stop insulin: If the patient is on insulin, ensure they understand that insulin must not be stopped during intercurrent illness and doses may need adjustment.
• Consider comorbidities and individual factors: Tailor treatment choices based on the patient’s age, comorbidities, risk of hypoglycaemia, and preferences.
• Arrange timely follow-up: Monitor the patient closely to assess response to treatment and adjust therapy accordingly.

These steps align with NICE and expert consensus recommendations for managing acute hyperglycaemia in type 2 diabetes.

References: ¹,²,³,⁴,⁵