Inpatient Management of Hyperglycemia and Diabetes
- Jane Jeffrie Seley, NP, CDE, Guest Editor
I feel as if we have come full circle in diabetes care. Early in my nursing career, I began to focus on the care of people with diabetes in the hospital. Many people, especially those with type 1 diabetes, were admitted to the hospital at the time of diagnosis and spent several days learning how to inject insulin, measure glucose in urine, and make decisions about meals, physical activity, and medication. Diabetes educators were rare, and outpatient education programs were also few and far between. Short-term hyperglycemia was not considered harmful, and the use of sliding-scale regular insulin was pervasive.
Over time, insurance reimbursement for extended inpatient self-management education has been questioned, and the focus has shifted to outpatient services. Many believed hospitalization was lacking in “teachable moments,” as patients struggled with the stresses and strains of being acutely ill. In the past decade, compelling research into the consequences of short-term hyperglycemia in critically ill patients has provided a wake-up call. It appears that strict glycemic control in the hospital—even for those without a diabetes diagnosis—does matter after all.
Researchers continue to examine various patient populations and glycemic targets to help establish evidence-based guidelines. So, how do we improve the care we are delivering to our patients with diabetes once they are admitted to an acute-care facility? Most health care providers are not diabetes experts and are uncertain about how to effectively initiate and titrate insulin. Some are not aware of or have not embraced the glycemic targets recommended for inpatients by the American Diabetes Association and the American Association of Clinical Endocrinologists.1In addition, many standard hospital routines and treatments can sabotage our best efforts to …
