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In the ED: Fasting history is unreliable Treat as higher aspiration risk especially if symptomatic Anticipate vomiting and difficult visualization Practical considerations: Optimize positioning (ramped, head elevated, or slight reverse Trendelenburg) Use RSI when appropriate Minimize bag-mask ventilation Ensure suction is immediately available and functioning

Contact your GP or diabetes care team if you experience: Vomiting that persists for more than 24-48 hours Inability to keep down fluids, leading to signs of dehydration (dark urine, dizziness, dry mouth, reduced urination) Vomiting accompanied by abdominal pain Blood in vomit or vomit that resembles coffee grounds Significant unintentional weight loss beyond expected therapeutic effects Symptoms of hypoglycaemia (low blood sugar) that you cannot manage, particularly if you are also taking insulin or sulfonylureas Seek urgent medical attention (A&E, NHS 111, or call 999) if you develop: Severe, persistent abdominal pain with vomiting, particularly if the pain is constant and located in the upper abdomen radiating to the backthis could indicate pancreatitis

however, members may still be on longer if they determine, with their clinician, they need additional support