Insulin requirements usually increase during illness or infection and patients should be advised to monitor their blood glucose more often and adjust their insulin doses appropriately during this time. ‘Sick day rules’ are a key safety measure community pharmacy teams can remind patients of. Where patients do not administer enough insulin, they could develop hyperglycaemia, early signs of which include polydipsia (excessive thirst), polyuria (abnormally large production/ passage of urine), loss of appetite, nausea, vomiting and dry skin. Untreated hyperglycaemia can lead to diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic syndrome (HHS), both of which require hospitalisation.

Patients should contact their diabetes team if they are unsure of what to do during periods of illness. Community pharmacists and their support staff can check patients’ understanding of how to use their insulin when unwell or if experiencing higher than usual levels of stress.