Type 2: Medications & Sick Day Rules
What the common type 2 medications do, and the Australian SADMANS guide to which ones pause during serious illness.
Sick days with type 2 diabetes
Rhiannan's practical walkthrough video coming soon.
What to know
The medication landscape
Metformin (first-line tablet), sulfonylureas like gliclazide (can cause hypos), DPP-4 inhibitors, SGLT2 inhibitors (dapagliflozin, empagliflozin), GLP-1 injectables (semaglutide, dulaglutide) and insulin. Only insulin and sulfonylureas carry real hypo risk.
SADMANS: the sick day pause list
When someone is seriously unwell, vomiting, diarrhoea, fever, unable to keep fluids down, some medications are usually paused to protect the kidneys: Sulfonylureas, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs, SGLT2 inhibitors. That's SADMANS. It is general Australian guidance, and the person's own doctor or pharmacist confirms what applies to them.
Insulin is not on the pause list
People on insulin generally keep taking it during illness, often needing more, not less. Never encourage someone to stop insulin because they aren't eating.
Fluids and monitoring
Small, frequent sips. Check glucose more often than usual. If they can't keep fluids down for more than a few hours, that's a call to the doctor or Virtual ED, or 000 if they are drowsy, confused or breathing hard.
What to do, in order
- Ask whether they have a written sick day plan from their GP or diabetes educator.
- Encourage small, frequent sips of fluid.
- Remind them SADMANS medications may need pausing, and that their doctor or pharmacist confirms it.
- Never suggest stopping insulin.
- Check glucose more often while they are unwell.
- Escalate if vomiting continues, they can't drink, or they become drowsy or confused.
Test your instincts
Read each situation, then reveal the options.
Your dad has type 2 diabetes, takes metformin and dapagliflozin, and has had vomiting and diarrhoea since last night.
What's the most useful thing to say?
Show the optionsHide the options
A friend with type 2 on insulin has a fever and isn't eating much. She says she'll skip her insulin tonight since she hasn't eaten.
How do you respond?
Show the optionsHide the options
This is general first aid education, not personal medical advice. In an emergency in Australia, call 000.