Diabetes Forecast

Caregiving Tips for Hospital Stays

By Lindsey Wahowiak , ,

When someone with diabetes is hospitalized, it's important for you, the caregiver, to have a game plan. Experts share their tips for how to make hospital stays less stressful—and returns home safer.

Be Part of the Health Care Team
You are already part of your loved one's diabetes care team. So don't be afraid to assert yourself and get answers from doctors and nurses, says John Schall, CEO of the National Family Caregivers Association. "Make it very clear that you're the caregiver and that you want to be a resource to the team in the hospital," he says. That includes providing information. You're likely to be asked many questions about your loved one's medical history. It's helpful to have that written down, along with a list of his or her allergies, medications, and doses. Don't assume it's already in your loved one's chart—sometimes doctors are moving fast and there are gaps between providers. Working with the nurses, "your greatest ally," Schall says, will help you get to the nitty-gritty of the hospital care.

Jackie Bradley, 51, of Portage, Mich., became part of her father-in-law's care team when he was hospitalized for a hip injury last summer. When sorting out his medical information, Bradley, who herself has type 2 diabetes, found that her type 2 father-in-law, Jim Rowan, had some major holes in his diabetes management. He insisted that he had to take medications only twice a day, while the labels clearly indicated he should have been taking several of them three or four times a day, she says. "He also had medications prescribed by four different doctors, yet was following instructions given to him from his previous doctor [whom he saw 10 years ago]." By working with the hospital team, Bradley was able to streamline Rowan's diabetes self-care, too.

Take a Step Back
While your loved one is hospitalized, it may feel awkward or even difficult for both of you to relinquish control of diabetes care, but hospitalizations can require changes in management, says Rita Kalyani, MD, MHS, assistant professor of medicine in the Johns Hopkins School of Medicine's Department of Endocrinology. For instance, people with type 2 diabetes may need to stop taking metformin or other medications if they're going through an imaging procedure that requires contrast dye, such as a CAT scan. People who aren't using insulin injections at home may need to do so while hospitalized. And people facing major surgical procedures may have to temporarily stop using their insulin pumps so doctors can regulate their glucose levels more closely with intravenous insulin.

Changes to diabetes management can be a nerve-racking experience, particularly for caregivers who very closely monitor their loved ones' diabetes care. But the hospital health care team is there to provide specialized and nuanced assistance, from carb counting (especially when patients are getting nutrition from an IV or feeding tube) to testing blood glucose levels.

Kalyani suggests talking with nurses, dietitians, and doctors to make sure everyone's on the same page about who is responsible for certain aspects of diabetes management during the hospital stay. "In no way is the role of the patient or the caregiver minimized. Certainly they're an active part of the health care team," Kalyani says. "[But] the health care team also needs to provide direction on how diabetes is being managed while in the hospital."

Bring in Your Loved One
Involving your loved one in his or her care is empowering, says Rhonda Randall, DO, chief medical officer of UnitedHealthcare Medicare and Retirement. "Be a cheerleader," she says. "[Say,] 'You need to go through some challenges to return to health.' "

If diabetes is the reason for the hospitalization, there's much you can learn together. Shlinda James took detailed notes when her 12-year-old son, Javontae, was diagnosed with type 1 diabetes. "I wrote down any question that I might have for the doctor," she says. Javontae was part of the question-answer process. "He was involved in every conversation [and we] never left him out, even though he was 11 at the time."

Emotional support is crucial, too. Sara Jaouad, 29, of Phoenixville, Pa., has type 1 diabetes and was hospitalized last year. Having her husband, Hassan, with her was a huge comfort, she says: "He was by my side at all times, smiling and telling me that even in a hospital bed I still looked good."

Look Toward the Future
"Everybody kind of forgets it," says Schall, "but probably the most important part of the whole thing will be the discharge process. That transition time is when things can get very, very critical." From the beginning of a hospital stay, start thinking about getting your loved one home, and talk to his or her caseworker about what that process might be like. Will your loved one need home health care? New health equipment? Will you need to figure out finances? Making a successful transition from hospital to home, or to a long-term treatment facility, reduces the chance of readmission within the next 30 days. Nearly 1 in 5 patients is readmitted for a related health issue, according to Mayo Clinic data.

Care for Yourself
Elizabeth Knight, 29, of Lexington, Ky., says that when her father, Ralph Worster, was hospitalized because of complications from his type 1 diabetes, she turned to food for comfort—a worry because of her type 2 diabetes. Because her family is supportive, though, she was also able to join a gym, work off some of her stress, and talk about her emotions, especially with her husband, Clinton. Being able to keep some balance helped her control her diabetes as well. "It is a time when you learn about yourself and about the ones who step up to the plate to help out," she says. Taking time out for yourself is not selfish—it's smart.



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