When to stop non-insulin diabetes medications

Diabetes & endocrinology
NHS Lothian

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)

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)