This summer, I worked on an educational CD-ROM for nurses who provide care for patients with diabetes in the hospital setting. In preparation for this project, I became immersed in the medical and nursing literature addressing the care of hospitalized patients. This forced me to take a hard look at the delivery of diabetes care and confront the reality that inpatient diabetes management has often failed to meet the standard of care seen in outpatient settings.

Thirteen years ago, I worked as a clinical nurse specialist in diabetes in a major hospital. The problems in the management of diabetes that I confronted at that time are the very same problems that persist to this day: poor timing of meals and insulin doses, varying methods for treating hypoglycemia with few standard protocols, performance of glucose monitoring hours before insulin dosage decisions are made, inappropriate nutrition substitutions for medically necessary dietary adjustment, removal of insulin pumps before surgery... and the list goes on.

In the years since I worked at that hospital, the results of landmark diabetes research studies such as the Diabetes Control and Complications Trial, the U. K. Prospective …