When to stop non-insulin diabetes medications

• Given any time of day
• Check BNF - some require dose reduction in acute kidney injury
• Withhold if vomiting

• Given at mealtimes
• Withhold or reduce dose if:
  • hypoglycaemia
  • reduced oral intake
  • acute kidney injury

• 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)

** Please note there is a global shortage of GLP-1 agonist medication until mid 2024 **

If a patient brings in their own supply, these can be given but it is possible the hospital will struggle to supply these medications in the longer term

An alternative medication may need to be considered if control is poor  

• 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

• Given any time of day
• Stop and discuss with diabetes team if:
  • fluid overload
  • deranged LFTs
  • new fracture
  • bladder cancer

• 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)

• 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)
• Remember to consider restarting medications on discharge