Before you leave the hospital, make sure to ask how to maintain your blood glucose control once you’re home. If you already used insulin before coming to the hospital, your insulin needs may be higher than before if you were in the hospital for surgery, have been treated for an infection, or are now less active. They may be lower if you have lost weight or are eating less.
If you did not use insulin before your hospitalization, you may need to continue to take it — at least temporarily — to maintain your blood glucose levels in an optimal range when you go home. If so, you should be taught how to give an insulin injection before your discharge by a health-care professional who is knowledgeable in the use of insulin. Many hospitals have diabetes educators on staff who specialize in diabetes training. The diabetes educator can help you learn about your diabetes treatment plan and may also recommend that you return for additional training as an outpatient once you have recovered from your hospital stay.
Bedside blood glucose monitoring
Keeping track of your blood glucose levels while you are in the hospital is important to help the physicians and hospital staff be sure that your inpatient diabetes treatment plan is working (or make changes if it isn’t). The blood glucose monitoring that is done in the hospital is similar to the monitoring you do at home, except that a hospital meter is used, and someone else is lancing your finger and checking the blood. Just like at home, your results provide immediate information for timely decision making with regard to your diabetes treatment plan. Hospital staff will also perform regular testing of the meter itself to assure that it is sound and is giving accurate results. For this reason, hospitals prefer to use their own equipment for blood glucose monitoring, rather than the patient’s home meter. The hospital will have a system in place for recording the results of each blood glucose reading in your hospital record. (Click here to learn about blood glucose goals in the hospital.)
The timing of the blood glucose monitoring you receive in the hospital will usually be based on your individual needs. For patients who are eating, the usual recommendation is to monitor before each meal and at bedtime. For patients who are not eating, monitoring will likely occur every 4–6 hours to assess insulin needs. If your diabetes is being managed with an insulin drip, your blood glucose will typically be monitored hourly until it is stable, and then usually every two hours from then on.
Efforts to avoid hypoglycemia are an important part of the in-hospital diabetes management plan. Any reductions in food intake increase the risk for hypoglycemia if your insulin doses have not been adjusted to accommodate these changes. Another thing that could contribute to hypoglycemia is less-than-optimal timing of premeal insulin doses to match the timing of meals.
If hypoglycemia does occur, the hospital should have a treatment protocol to manage it. The treatment you receive is usually based on how low your blood glucose is. You may want to ask the hospital staff ahead of time how hypoglycemia is treated so you know what to expect should the need arise.
Nutrition in the hospital
Adequate nutrition is important for the healing process. While you are in the hospital, a food plan is usually determined and delivered by the hospital’s dietary service, which is staffed by registered dietitians and other nutrition professionals. Many hospitals use a “consistent carbohydrate” food plan for patients with diabetes, in which the patient makes food choices for each meal that add up to the recommended total carbohydrate grams per meal.