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What to Expect in the Hospital
“The wish for healing has ever been the half of health.”
Most people experience a stay in the hospital at least once in their lives, and for some, it is much more often than that. No matter what the reason for your admission to the hospital, it is imperative that your blood glucose levels be controlled while you are there.
More and more research shows that maintaining optimal blood glucose control in the hospital improves a person’s chances of having the best possible medical outcome. However, achieving optimal control in the hospital is a challenge. Stress tends to raise blood glucose level, and in the hospital, the stresses are many: Illness itself is a physical stress, as are pain, surgery, and other medical procedures such as having blood drawn for tests. Simply being in the hospital is a physical and mental stress with all of the changes in routine. And worrying about the reason you’re in the hospital, whether your diabetes is being controlled properly, how much the hospitalization is going to cost you, how your family or job is making out without you, etc., simply adds to it.
If your hospital admission is not an emergency, you and your health-care provider have more time to prepare so that some of the stress of being in the hospital can be minimized. For example, you can establish ahead of time whether your personal physician will be overseeing your care while you’re in the hospital or, if not, who will. You can also discuss how your diabetes will be controlled and whether and when to stop taking any medicines you may currently take. And you can make plans for dealing with such personal responsibilities as child care or pet care during your hospital stay.
If you are admitted to the hospital through the emergency room, it is standard practice for the hospital to try to notify your primary-care physician. If your primary-care physician has privileges to practice in that particular hospital, he may come to see you there. If not, you will be treated by a physician on the hospital staff. Once you are released, it’s a good idea to follow up with your personal physician and make him aware of your recent hospitalization.
Your hospital diabetes plan
Controlling blood glucose in the hospital
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:
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.
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
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.
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
If you are scheduled for surgery, you may need to follow a “full liquid” or “clear liquid” diet in preparation. The liquids served in place of solid food will contain carbohydrate and will not be sugar-free.
It’s also possible that you will need an alternative form of feeding such as the use of a feeding tube (called enteral feeding) or intravenous feeding (called parenteral feeding). In these cases, your physician, in consultation with the hospital dietitian, will decide on the desired formulation of nutrients.
Before you leave the hospital, a registered dietitian who is familiar with the effect of food choices on blood glucose levels in people with diabetes will usually advise you on eating at home. The registered dietitian is responsible for integrating information about your condition, your eating and lifestyle habits, and your treatment goals to come up with a realistic, individualized meal plan for you. The registered dietitian may also recommend that you return as an outpatient for further nutrition counseling after you leave the hospital.
Being your own advocate
In the event that you receive treatment in an emergency room or at an urgent care facility, it’s possible that you will know more about the latest technology for diabetes control than the people caring for you. Medical professionals who do not provide routine diabetes care, for example, may not be familiar with insulin pumps and how they work. If you use an insulin pump and are asked to remove it in one of these settings, you will need to communicate your urgent need for a physician’s order for an alternate method of insulin delivery to avoid developing high blood glucose.
Once admitted to the hospital, if you question any aspect of your inpatient diabetes treatment plan, ask for clarification. If you don’t feel able to speak up for yourself but do have a friend or family member who can do it for you, ask that person to speak with your caregivers in the hospital about your concerns.
With a physician’s order, a person with diabetes may be able to assist in managing his diabetes while in the hospital, as long as he is mentally competent and has a stable level of consciousness. A physician is also more likely to agree to self-management during the stay if a person has relatively stable insulin requirements and experience in managing his insulin doses and blood glucose monitoring at home. The patient and physician, in consultation with the hospital nursing staff, must agree that patient self-management is appropriate under the conditions of hospitalization and together must ensure that it is conducted according to hospital policy.
If you are managing your own diabetes in the hospital, all of your self-directed care should be reported to the nurse or other hospital staff member assigned to your care and documented by the staff member in your hospital record. Also, it is important to speak up if you don’t feel well enough to carry out your care or need assistance with your diabetes treatment plan at any time during your stay.
No matter what has put you in the hospital, diabetes management should always be a priority. Optimal blood glucose control during your stay may hasten your trip down the road to recovery.
Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.