Patient handout

Type 2 diabetes (chronic outpatient)

PRODUCTION

1. Your condition

This handout is for type 2 diabetes (chronic outpatient). Your care team identified this based on: hba1c ≥6.5% / elevated fpg / 2-h ogtt ≥200 (ada 2026 §2 diagnostic criteria).

Other reasons your team may use this plan: polyuria + polydipsia + weight loss per ada 2026 §2; established t2dm (titration / annual review per ada 2026 §4); prediabetes for surveillance + dpp referral per ada 2026 §3.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
metformin	500 mg	PO	BID with meals; titrate to 1000 mg BID over 4 wk	ADA 2026 §9 foundation; A1c approx -1.0 to -1.5%, glycemic effect 1-2 wk. UKPDS 80 legacy: metformin MI -33% (p=0.005), all-cause death -27% (p=0.002) at 10 y post-trial (PMID 18784090). B12 q1-2y after 4 y.

Plan: ADA 2026 §9 — comorbidity-first glycemic stepwise ladder (cardiorenal indications independent of A1c)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — On track — at A1c + glucose target per ADA 2026 §6

If you have:

Fasting BG within personal target (often 80–130 mg/dL) per ADA 2026 §6
Postprandial BG <180 mg/dL per ADA 2026 §6
No hypoglycemic episodes per ADA 2026 §6
No new symptoms (polyuria, polydipsia, weight loss) per ADA 2026 §2
Adhering to medication + lifestyle plan per ADA 2026 §5

Do this:

Continue all medications as prescribed per ADA 2026 §9 (do not skip if feeling well)
Maintain MNT, activity, weight goals per ADA 2026 §5
Keep scheduled labs + appointments per ADA 2026 §4
Continue daily foot inspection + dental hygiene per ADA 2026 §12

YELLOW — Caution — sick day OR mild hypo OR hyperglycemia trend per ADA 2026 §6

If you have:

Acute illness (fever, vomiting, diarrhea, infection) per ADA 2026 §6 sick-day rules
Glucose 70–80 mg/dL (mild low) OR fasting >180 / postprandial >250 mg/dL per ADA 2026 §6
Increased thirst, urination, fatigue per ADA 2026 §2
New medication (steroid, antipsychotic) in last 1–2 weeks per ADA 2026 §4
Weight loss without trying per ADA 2026 §2

Do this:

SICK DAY RULES per ADA 2026 §6: Do NOT stop insulin (basal continues even if not eating; reduce prandial 50% if poor PO); HOLD SGLT2i during acute illness with poor PO (ketosis risk per FDA 2015 class warning); HOLD metformin if dehydrated/AKI risk; HOLD ACEi if dehydrated
Monitor BG q2–4h while ill per ADA 2026 §6
Check ketones (urine or blood BHB) if T1DM or on SGLT2i with BG >250 per ADA 2026 §6
Hydrate aggressively per ADA 2026 §6 sick-day management
For mild hypo (BG 54–70): 15 g fast carb (4 oz juice, 3–4 glucose tabs), recheck in 15 min, repeat if still <70 per ADA 2026 §6
Increase BG checks to QID until back to baseline per ADA 2026 §6
Contact provider if illness >24h, ketones moderate-large, BG >300 persistent, or vomiting per ADA 2026 §6

Call your provider if:

Persistent hyperglycemia >300 mg/dL x 24h per ADA 2026 §6
Moderate-large ketones per ADA 2026 §6
Inability to keep PO down per ADA 2026 §6
Severe hypoglycemia or hypoglycemia unawareness per ADA 2026 §6

RED — Emergency — DKA, HHS, severe hypoglycemia, foot infection, AMS per ADA 2026 §16

If you have:

Severe hypoglycemia (BG <54 OR requiring assistance OR LOC) per ADA 2026 §6
BG >400 mg/dL with ketones / Kussmaul breathing / vomiting / abdominal pain per ADA 2026 §16
AMS, confusion, seizure, coma per ADA 2026 §16
Severe foot infection (red streaks, fever, deep ulcer with exposed bone) per ADA 2026 §12
Chest pain or new neuro deficit per ADA 2026 §10

Do this:

Severe hypo: caregiver gives IM glucagon 1 mg + call 911 per ADA 2026 §6
Hyperglycemia + ketones / vomiting / AMS: call 911 + go to ED for DKA/HHS workup per ADA 2026 §16
Severe foot infection: ED now per ADA 2026 §12
Chest pain / stroke symptoms: 911 per ADA 2026 §10
Bring all medications + insulin to hospital per ADA 2026 §16

Call your provider if:

Any red zone trigger — go to ED, do not wait per ADA 2026 §16

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

A1c >10% OR fasting BG >250 with symptoms per ADA 2026 §9
≥1 severe hypo event OR hypoglycemia unawareness reported per ADA 2026 §6
T2DM patient planning pregnancy or pregnant per ADA 2026 §15
T2DM patient on SGLT2i with intercurrent illness, surgery within 72h, ketogenic/low-carb diet, prolonged fasting, alcohol binge, or insulin reduction — at risk of euglycemic DKA (glucose <250 with AGMA + ketones) per ADA 2026 §9 + FDA 2015 SGLT2i class warning
GLP-1 RA or tirzepatide on board with new severe abdominal pain, persistent vomiting, elevated lipase ≥3x ULN per ADA 2026 §9 class label warning

5. Follow-up

DSME, vaccinations (flu/pneumococcal/COVID/RSV/Tdap/HepB/zoster), psychosocial + fear-of-hypoglycemia + anxiety screen (ADA 2026), pre-pregnancy counseling

6. Sources

Guideline: ADA Standards of Care 2026 + AACE 2023 + KDIGO 2024 Diabetes-CKD + EASD/ADA 2022 Hyperglycemia Consensus + 2026 ACC/AHA Lipid + 2025 AHA/ACC HTN + AASLD 2023 MASH (resmetirom 2024 FDA approval)