HELP ON DIABETES

Managing Your Diabetes During Hospitalizations

PLANNED HOSPITALIZATION

To get optimal treatment for your diabetes when you have a planned admission to the hospital for medical or surgical treatment, you need to consider the following.

Before Going to the Hospital

Talk to your prospective medical team about your diabetes management while in the hospital:

• Who will be involved in managing your diabetes? Does the hospital have a diabetes nurse specialist? 
• Are you going to stay on your oral medicines, or will they switch you to insulin injections for the duration of your stay? 
• What about meals: how long before you can eat normally? 
• When you leave the hospital, will you be able to go back to your regular medicines, or will you require insulin for a short time? 
• Can you use your insulin pump in the hospital? If not, you should switch to a basal-bolus insulin injection regimen a few days before you go in. 

  Talk to your family members about your diabetes and keep them involved so they can be your advocates if you cannot speak for yourself. Take the following things with you to the hospital:

• Several copies of a list of all your medicines—the doses and how often you take them; your insulin regimen, including the scale you use to adjust for high glucose levels; and any known food or drug allergies (take several copies because almost invariably, the doctor or nurse will misplace your first copy) 
• The bottles of all your medicines 
• A list of all your previous illnesses and when they occurred 
• Your diet at home: how many grams of carbohydrate you usually eat at each meal 
• Your diabetes kit, including your blood glucose monitor and lancet device, blood glucose strips, glucose log, glucose tablets, insulin syringes, and your insulin vial or pen 
• Insulin pump supplies if you are going to use your pump in the hospital 
• Your MedicAlert bracelet 
• Your advanced health directive: this gives your medical team guidance about what kind of care should be given to you if you cannot make decisions for yourself, and the name of the person whom you designate to make health decisions on your behalf 

While You Are in the Hospital

Glucose management in the hospital can be challenging for a number of reasons:

• The stress of the illness or operation can raise your blood glucose, and the doses of the diabetes medicines you normally use may not be suffi cient to control the glucose rise. 
• There may be altered schedules of eating and activity in the hospital. You might have to be fasting for various procedures; food may arrive at different times; you may not want to eat because of your illness; and the food is different from what you are used to. 
• The oral diabetes medicines may have to be stopped because they may not be safe to use while you are ill, and you will be switched over to insulin during the hospital stay because it can be rapidly adjusted to meet your altering needs. 

If you have type 1 diabetes or you have type 2 diabetes and are on insulin and you are not going to eat for twenty-four hours or more, you may be given insulin and fluids into the vein (an insulin infusion) to keep your glucose under control. The nurse will adjust the insulin infusion based on finger-stick blood glucose tests per­formed every one to two hours. The infusion is continued until you are eating, and then you will be switched to subcutaneous injections.

The usual insulin regimen is a fast-acting insulin before meals, and if insulin is needed overnight, either NPH, insulin detemir, or insulin glargine at bedtime. A small correction of fast-acting insulin might also be needed at bedtime and 2 A . M . People with type 2 diabetes can sometimes be given premixed insulin twice daily.

To help keep your glucose levels under control while in the hospital, do the following:

• Keep your diabetes kit nearby so you can check your glucose if you need to. Also ask the medical care team if you can have glucose tablets or juice available in case you have a hypoglycemic reaction. 
• Ask to see the nutritionist and explain your diet plan to him or her so that you can get the meals that you desire. 
• If the hospital has a diabetes nurse specialist, work with him or her to troubleshoot problems. 
• Work with the nurses on the timing and dosing of your diabetes medicines. If your food arrives but the nurse has not come by to give your insulin injection, you should call the nurse to give your injection before eating. 

• Also, if you know that your appetite is not normal, eat the carbohydrate foods first. If you are not sure that you will be able to keep any food down, ask the nurse to let you eat first and then give you your fast-acting insulin analog. 
• Keep talking to your medical team about your glucose control, and request an endocrine consultation if your diabetes control is proving diffi cult to manage. 

As you recover and are getting ready to go home, your medical team may switch you back to your usual diabetes medicines. However, if it looks like you are going to stay on insulin, the inpatient diabetes team—the diabetes nurse specialist, phar­macist, and nutritionist—will teach you how to count carbohydrates and how to inject and adjust insulin.

When You Are Discharged from the Hospital

Before you leave the hospital, talk to the pharmacist or diabetes nurse specialist and make sure that you know how to take your diabetes medicines and how often to check your blood glucose levels. If you are on insulin, know how to adjust the insu­lin as your food intake and activity changes and what to do when you have low or high glucose values. You should also know whom to call if there are problems.

After discharge, schedule an appointment with your primary care physician to review your diabetes management.

EMERGENCY HOSPITALIZATION

Even though you cannot know when an emergency will happen, you can plan ahead. Make plans for an unexpected hospitalization by doing the following:

• Always keep an updated list of your medicines, including doses, in your wallet and wear your MedicAlert bracelet. 
• If you are on insulin or oral diabetes medicines that can cause low blood glucose reactions, you should have your diabetes kit with you at all times. 
• When you are admitted to the emergency room, make sure that the medical staff members know you have diabetes. 
• Keep contact information for family members or friends in your wallet. 
• If you are in the emergency room for a long time, have the emergency room nurses check your blood glucose levels from time to time. If you are not feeling well, keep asking until you get help.  
• Talk to your next of kin before any such event, and let them know where you keep your medicines and diabetes supplies at home and where your durable power of attorney form for health care is kept so that you can have them bring these to the hospital.