Diabetic patients must follow a regular, prescribed diet and exercise schedule to avoid either hypo- or hyperglycemia. Fever, thyroid disease, infection, recent trauma or surgery, diarrhea secondary to malabsorption, vomiting, and certain medications can affect requirements of antidiabetic agents; dosage adjustments may be necessary. Diabetic patients should be given a 'sick-day' plan to take appropriate action with blood glucose monitoring and their antidiabetic therapy, including liraglutide, when acute illness is present. Temporary use of insulin in place of oral antidiabetic agents may be necessary during periods of physiologic stress (., burns, systemic infection, trauma, surgery, or fever).
Treatment of children and infants on insulin therapy (including regular insulin; isophane insulin, NPH) requires special care. In general, special attention must be given to caloric intake, insulin dosage adjustments, and avoidance of low blood glucose concentrations. Because children < 5 years of age may not be able to identify symptoms of hypoglycemia, several pediatric textbooks recommend less stringent goals for fasting or preprandial blood glucose concentrations (100—200 mg/dL) and HbA1C (—9). The majority of insulin preparations have been studied in pediatric patients; however, it may be difficult to achieve glycemic control in children with fixed ratios of quick-acting and intermediate-acting insulin mixtures. When using fixed ratio mixtures of insulin, both insulin types (., the quick-acting and the intermediate-acting components) are adjusted upward or downward which may affect glycemic control undesirably.