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if someone got linagliptin 5 mg and empaglifogil 25mh with insilin 30/70 mixtard in the morning blood suger two hour after breakfast 20 mmol.should he take anti diabetic now

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ADA hyperglycemia blood glucose 300 mg/dL ketones emergency symptoms sick day insulin SGLT2 inhibitor

20 mmol/L (about 360 mg/dL) 2 hours after breakfast is dangerously high. Do not take an extra dose of linagliptin, empagliflozin, or Mixtard 30/70 unless their diabetes clinician has given a written, specific correction-dose plan. Taking extra mixed insulin without an individualized plan can cause delayed severe hypoglycemia.
Do this now:
  1. Check blood or urine ketones immediately, if available. This is particularly important because empagliflozin is an SGLT2 inhibitor and raises the risk of diabetic ketoacidosis. The ADA ketone guidance advises ketone testing when glucose is at least 250 mg/dL (13.9 mmol/L) for 2 hours.
  2. Drink water or other sugar-free fluids if able to drink normally.
  3. Do not miss their usual insulin, but do not add extra insulin unless a clinician has already told them exactly how much to use for a correction.
  4. Call their diabetes doctor, urgent-care service, or local emergency advice line now for dose-specific instructions. They need review today because 20 mmol/L despite morning treatment may need urgent assessment and a revised insulin regimen.
  5. Go to the emergency department immediately if ketones are moderate/high, blood ketones are 1.6 mmol/L or more, or there is vomiting, abdominal pain, deep/rapid breathing, severe weakness, confusion, drowsiness, inability to drink, or worsening thirst/urination. These can indicate diabetic ketoacidosis, which needs hospital treatment. See ADA DKA warning signs.
If they have a prescribed correction scale using rapid-acting insulin, follow that exact scale only. Do not “double up” Mixtard 30/70 or the tablets to rapidly bring it down.
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