Controlling blood glucose in the hospital
Because not much is known about the use of diabetes drugs other than insulin in hospitalized patients, insulin is usually the drug of choice in the hospital, and other diabetes drugs are discontinued. (See “Diabetes Drugs in the Hospital” for more on this topic.)
The two methods of insulin delivery used in hospitals are continuous IV (intravenous) infusion, using a clear, short-acting insulin, and subcutaneous insulin — insulin given by injection under the skin or with an insulin pump — using a combination of long-acting and short-acting insulins or, in a pump, just short-acting insulin.
Intravenous insulin delivery is sometimes referred to as an “insulin drip.” An insulin drip is almost always used in the following situations:
- You are admitted to the hospital to have surgery (particularly heart surgery).
- You are having an organ transplant.
- You have high blood glucose because you are taking a drug or drugs that cause high blood glucose, such as high-dose glucocorticoid (steroid) therapy.
- You have Type 1 diabetes and are taking in no food by mouth.
- Your heart is not pumping effectively (a condition called cardiogenic shock) and there is inadequate blood flow in your body.
- You are critically ill.
Insulin drip therapy is also used to treat diabetic ketoacidosis and hyperosmolar hyperglycemic state, both of which are life-threatening complications of diabetes that occur as a result of prolonged high blood glucose levels coupled with inadequate insulin and dehydration. These conditions sometimes occur in people who are not aware that they have diabetes. In women with pre-existing diabetes who are pregnant, an insulin drip may be used to control blood glucose levels during labor and delivery.
Subcutaneous insulin therapy is more likely to be used in people are not critically ill. A variety of insulins may be used, depending on a person’s needs and why he is in the hospital. Typically, both basal insulin (“background” insulin that’s needed between meals and over-night) and mealtime insulin (insulin needed to cover food intake) are given. A person’s in-hospital insulin plan also typically includes instructions for supplemental, or “correction,” doses in the event of high blood glucose levels. Similarly, the insulin plan should include instructions for treating hypoglycemia.
The uncertainty of the daily routine in the hospital can make controlling blood glucose difficult. For example, the schedule for meals and insulin doses may be different from one day to the next because of tests or procedures that need to be done. However, if you are requiring correction doses or hypoglycemia treatments frequently, your physician will likely change your routine insulin dosing plan in an attempt to prevent frequent highs or lows.