5 Tips for Managing Diabetes in the Hospital
1. Manage Medication
Diabetes self-management is uncommon in the hospital. Because you may be unable to manage on your own, it is safer to have medical staff check blood glucose levels and give medicine. But if you are able to care for yourself, your medical team will likely work with you, says Sandra Weber, MD, FACP, FACE, vice president of the American Association of Clinical Endocrinologists, professor at the University of South Carolina School of Medicine–Greenville, and chief of the Section of Endocrinology at the Greenville Health System.
“Most people with any type of diabetes like to be in control,” she says. “Their knowledge of their body is vital.” But she cautions that, in a hospital setting, there are challenges that people have not experienced before, such as fasting and new medications. When it comes to noncritical hospital stays, the 2018 Standards of Medical Care in Diabetes from the American Diabetes Association (ADA) recommends that patients be treated with basal (long-acting) insulin and bolus (rapid-acting) correction doses, with the addition of mealtime insulin in people who are eating well.
What does that mean for you? If you wear an insulin pump and are capable of using it, you’ll continue receiving basal and bolus insulin that way. Even if you don’t typically use insulin, your doctor may give it to you (instead of your usual oral or injectable diabetes medications) to manage blood glucose during your stay. This is for your safety, Weber says, because many non-insulin medications rely on normal kidney and liver function, consistent eating, and stable medical status.
2. Connect Your Teams
When you’re admitted to the hospital, ask the doctor who’s caring for you to consult your regular endocrinologist or the doctor who typically cares for your diabetes. If your usual care providers are unavailable, an endocrinologist or diabetes educator on the hospital’s staff may be consulted to help navigate the transition from home to hospital care, says Kellie Antinori-Lent, MSN, RN, ACNS-BC, BC-ADM, CDE, a diabetes clinical nurse specialist in nursing education and research at UPMC Shadyside Hospital in Pittsburgh and a spokeswoman for the American Association of Diabetes Educators. Discuss your diabetes treatment plan with your hospital care team. One of the best ways to do that is to have your regular regimen written down. “Paper communication of your regimen leaves no room for error that can be seen with verbal communication,” Antinori-Lent says. She recommends also including contact information for your diabetes care providers. Hospital staff “will appreciate knowing who to call if they have questions.”
3. Understand the Treatments for Lows
While stress can increase your blood glucose, other aspects of a hospital stay—the fact that you may not be eating as much, for instance—can make low blood glucose (hypoglycemia) more likely. Hospital staff will monitor your blood glucose regularly and are trained to spot the signs of a low (see diabetesforecast.org/signsoflows for a full list). The ADA recommends treating for hypoglycemia starting at 70 mg/dl in the hospital. If you’re able to swallow, a nurse will give you glucose gel or liquid. If you’re not, you’ll receive glucose intravenously. Weber says that’s why many hospital patients have an IV port inserted.
4. Monitor Your Blood Glucose
Because illnesses can make blood glucose more unpredictable, hospital staff will likely be checking your blood glucose more frequently than you would at home. To do so, they’ll use the hospital’s equipment—typically higher-grade devices than your own meter. Nurses will log each reading on your chart, and you can ask for your electronic health records so you can see your data for your full hospital stay. But you should still feel free to check on your own, says Weber.
5. Get Familiar With the Food
While in the hospital, you might not have a one-on-one meeting with a dietitian, but there is always one reviewing every hospital meal and menu, counting carbs, reading labels, adding up nutrition information, and logging everything patients eat, says Kristen Gradney, MHA, RDN, LDN, operations director of Our Lady of the Lake Hospital in Baton Rouge, Louisiana. If you’re using insulin, your doctor and dietitian will make sure you get the right number of carbs for the units of insulin you’re taking. You can also ask to speak with a dietitian if you have preferred carb counts or if you have questions about the food you’ll be getting. “Always feel empowered,” Gradney says. “While you’re in the hospital, there’s still some accountability. You still take care of yourself, even if others are taking care of you.”