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Diabetes in the Hospital: Taking Charge

First, find out the basics. You may be in the hospital for a short-stay surgery or test, a planned surgery, an illness, or a diabetes complication. Ask questions. Why does your doctor think you need to be in the hospital? Are there other options? What risks are there? Will you need someone to care for you at home? If you are having a procedure, you may wish to see another doctor for a second opinion. How long will you be there? If you do not understand the answers, ask again.

Before You Go

Talk to your doctor about handling your own diabetes care in the hospital. If you tend to stay in good control, your doctor may allow you to test your own blood glucose and take your own insulin or pills. If so, your doctor should put a self-management order in your hospital chart that says what you will do yourself.

If you can, also talk to the surgeon and other providers involved in your care. Tell each about your diabetes and other health problems. Ask whether and when you should stop taking your medicines. Ask how and by whom your blood glucose will be controlled during and after surgery. If you have a diabetes doctor or team, you have the right to ask that they manage your diabetes in the hospital.

Contact your health insurance company. Make sure your doctors and hospital accept your insurance. Find out how to get your treatment covered and what you will have to pay.

If you smoke, quit or cut down.

Remember to pack and put your name on:

• Slippers
  
• A copy of your meal plan
  
• Your medical history
  
• A list of the drugs you take (prescription and over-the-counter)
  
• A pocket carbohydrate guide to help you choose meals
  
• If you are on a insulin pump, take enough supplies for a daily site change.
  

Ask about taking your glucose meter, monitoring supplies, and drugs. Usually, the hospital will ask you to use their supplies. When you feel up to it, you may ask to take over monitoring fingersticks, injections, and diabetes management.

Find out what to expect after the procedure or treatment. Talk to your doctor and to others who have had the same treatment to help you prepare. For example, if you learn you should not drive for a week after you go home, stock up on food before you go.

At the Hospital

Good diabetes control in the hospital is vital. High blood glucose levels slow healing and increase your risk of infection. The American Diabetes Association recommends that blood glucose should be less than 180 mg/dl for people in the hospital or having surgery. For some, the goal is less than 110 mg/dl.

But good control in the hospital is hard for several reasons:

• Stress can raise blood glucose levels.
  
• Treatments may affect your blood glucose level.
  
• It may be hard to stick to your meal plan when you don't feel well or have few food options.
  
• Going for tests may make your meals, shots, or glucose tests late.
  
• Some hospitals let blood glucose levels get too high on purpose to prevent potentially harmful lows.
  
• Many hospitals dose insulin by the "sliding-scale" method, which can cause wild swings in blood glucose levels.
  

To make things easier:

• Ask that your meal plan be given to the hospital dietitian. If you can, talk to the dietitian about how to adapt it for your stay.
  
• Know that the hospital may change the doses of your diabetes drugs or put you on new drugs. You may be given an insulin drip or injections to aid in your healing and recovery.
  
• Changes in what you eat, the stress of illness or surgery, and the healing process can change the amount of drugs or insulin you need.
  
• If you're not in charge of your own diabetes care, call the nurse if your meal comes before your diabetes pills or insulin. Also, call if you've taken your medicine but your meal doesn't arrive.
  
• When you are admitted, tell the nurses what your usual symptoms are for high and low blood glucose.
  
• Keep glucose tablets close by in case your meal is late. Report symptoms of low blood glucose right away.
  
• If you are in pain, taking pain medicine, or not thinking clearly, ask family or friends to watch out for your diabetes care.
  
• Before going home, get written instructions for any changes in your usual medicines, meal plan, glucose testing, or exercise.
  
• If you are worried about caring for yourself at home, ask the nurse early on for help finding support.
  

Speaking up in the hospital is important. Ask questions. Be prepared. If you are concerned about your diabetes care, talk to your doctor, the nurse in charge, or your diabetes team.

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This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Social Bookmarking                What's this?