"Sick-day rules" center on never stopping insulin, more frequent glucose and ketone monitoring, aggressive hydration/carbohydrate intake, and temporarily holding certain oral/injectable agents that risk dehydration, AKI, lactic acidosis, or euglycemic DKA. The overarching principle for insulin-treated patients—especially type 1 diabetes—is that basal insulin must never be discontinued even when the patient is not eating, because counter-regulatory stress hormones drive hyperglycemia and ketogenesis regardless of oral intake.[1][2] Monitoring during illness - Check capillary glucose every few hours (roughly every 2-4 h, or every 6 h at minimum), and check blood or urine ketones at least twice daily in ketosis-prone patients.[1][3] - Maintain adequate fluids and carbohydrate intake; if unable to eat solids, substitute carbohydrate-containing fluids.[2][1] - Seek urgent care for persistent vomiting, inability to keep fluids down, reduced consciousness, significant ketosis, tachycardia, or hypotension—these signal impending DKA or volume depletion.[4][1] Insulin adjustment - Never stop basal insulin in type 1 diabetes (and insulin-requiring type 2), even with poor oral intake.[1][2] - For hyperglycemia/ketosis, increase insulin: consensus guidance recommends raising basal and bolus insulin by 10-20% based on glucose trends, with supplemental correction (rapid-acting) doses for ketones.[4][5] - For GI upset with reduced intake but feeling otherwise well, the prandial/bolus component may need reduction to avoid hypoglycemia while continuing basal.[5][2]

Stress raises blood glucose and worsens glycemic control in people with diabetes through both physiological and behavioral pathways, and chronic stress is also an independent risk factor for developing type 2 diabetes. Physiological mechanism. Acute stress activates the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, releasing epinephrine and cortisol. Epinephrine increases hepatic glucose production and inhibits insulin secretion, while cortisol mobilizes energy stores, drives gluconeogenesis, reduces muscle glycogen synthesis, and suppresses insulin secretion — effects that onset within minutes and can last several hours.[1][2] In diabetes, the underlying insulin deficiency or insulin resistance prevents the normal return to glucose homeostasis, so these adaptive responses produce sustained hyperglycemia.[1] Glucocorticoids specifically induce insulin resistance across multiple tissues: upregulating hepatic gluconeogenic enzymes (PEPCK, G6Pase), impairing GLUT4-mediated glucose uptake in muscle and fat, and impairing β-cell function and GLP-1 insulinotropic effects.[3][4][5] Both hyper- and hypoglycemia risk. The ADA Standards of Care 2026 note that stressful events (illness, trauma, surgery) increase the risk of both hyperglycemia and hypoglycemia, and in severe cases may precipitate life-threatening hyperglycemic crises (DKA, hyperosmolar states) — particularly in patients with clinical complexity and polypharmacy.[6] Acute stress in the inpatient setting. Acute stress impairs glucose control in both type 1 and type 2 diabetes, and stress-related dysglycemia (hyper- or hypoglycemia) in the hospital predicts short- and long-term morbidity and mortality in critical illness.[7]

https://sinclair.hms.harvard.edu/research

https://docs.google com/document/d/1rB3ZapY1cKSj0hXAeFbo0gPEc1jr8cWM/edit?usp=sharing&ouid=118181092252632675507&rtpof=true&sd=true

💉 GLP-1 Medications: Powerful Benefits Require Proper Care GLP-1 medications and GLP-1–GIP dual agonists have helped many people improve blood glucose, lose weight, and lower important health risks. But these medications are not “take the shot and forget about it” treatments. They require: • Careful dose increases • Good hydration • Proper nutrition • Symptom monitoring • Muscle-preserving activity • Communication with the healthcare team The goal is not simply to lose weight. The goal is to improve health while protecting the whole person. ❤️ Every Medication-Care Task Should Protect Three Things ❤️ The patient’s dignity 🛡️ The patient’s health and safety 💪 The caregiver’s health and safety Never shame someone because they feel nauseated, cannot finish a meal, regain weight, experience constipation, or need to slow down their dose increase. Side effects are not a character flaw. They are information that should guide safer care. 🧠 What Do GLP-1 Medications Do? These medications can: • Lower blood glucose • Reduce appetite • Increase fullness • Slow movement of food through the stomach and intestines • Support significant weight loss That slowing of digestion helps explain why gastrointestinal symptoms are the most common side effects. These symptoms often occur during dose escalation and are especially common during the first several weeks of treatment. 🤢 Common Gastrointestinal Side Effects Watch for: ✅ Nausea ✅ Vomiting ✅ Diarrhea ✅ Constipation ✅ Abdominal discomfort ✅ Bloating ✅ Reflux ✅ Feeling full very quickly Many symptoms improve as the body adjusts. However, persistent or severe symptoms should not be ignored. Some people stop treatment because gastrointestinal symptoms become too difficult to tolerate. The solution is not always to “push through.” Sometimes the dose needs to be held, reduced, or restarted more slowly under the prescriber’s direction. 🐢 Start Low and Increase Slowly One of the most important safety principles is: Do not rush dose escalation.