Diabetes management

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High blood glucose levels with COVID-19 infection have been shown to result in worse patient outcomes.

Recommendations

Check glucose on admission for all patients.

See detailed diabetes guidance here.

Patients not known to have diabetes

  • If glucose >12 on admission check the glucose 4 times daily (before meals and at bedtime).
  • If after 48 hours all glucose results are <10.0 mmol/L reduce frequency to once daily at 17.00-18.00 hrs.

Patients started on steroids (dexamethasone): monitor check blood glucose 4 times daily

  • Continue until steroid is stopped.
  • Discuss persistent hyperglycaemia with the diabetes team.

Patients known to have diabetes

  • Throughout the admission, check fasting glucose at least 6 hourly, or more frequently if the glucose is outside the 6.0 -10.0 mmol/L range.
  • Inform the diabetes team of admission.
  • Patients may need much higher doses of insulin than usual.
  • SGLT2 inhibitors (e.g. dapagliflozin. empagliflozin) should be stopped. 
  • Metformin should be stopped if eGFR < 30.
  • All patients on SGLT2 inhibitors should be discussed with the diabetes team.
  • All patients who are persistently hyperglycaemic should be discussed with the diabetes team.