Dr. Rita Kalyani, MD, MHS
People with diabetes enter the hospital for a variety of reasons—sometimes for poorly controlled blood glucose levels at home but often for reasons not related to their diabetes. Regardless of the reason for admission, people with diabetes require special care during their hospitalization. They may also need changes to their diabetes medications and special dietary considerations while in the hospital.
What You Need to Know
High blood glucose levels that are left untreated can make your hospital stay longer by:
- increasing the risk for infections,
- prolonging the time needed for wounds to heal,
- causing a build up of acid in the bloodstream,
- causing dehydration and kidney failure, and
- increasing the risk of complications after a solid organ or bone marrow transplant.
However, hypoglycemia can also be dangerous in the hospital. Unfortunately, an unpredictable schedule of diagnostic tests and varying meal times can increase the likelihood of hypoglycemia. Because of this, glucose goals in the hospital are typically less strict than at home. A goal glucose of 140 to 180mg/dL or 7.8 to 10.0 millimoles per liter (mmol/L) is appropriate for most hospitalized patients.
The hospital health care provider will tailor your care to keep blood glucose at safe levels. This is a challenging task because many common hospital procedures can complicate blood glucose management.
To work around these challenges, the hospital provider might make temporary changes to the daily medication regimen. Many people with diabetes are able to return to their regular regimen after leaving the hospital if they were previously well managed, but more often, some dose changes are made.
Medication Changes To prevent hypoglycemia or other side effects, particularly after certain hospital tests, oral diabetes medications (for example, metformin) might not be given during the hospital stay. Instead, with long-standing diabetes are given insulin (even those not previously on it). In the hospital, giving insulin is often preferred and can be adjusted based on changing dietary regimens and hospital procedures. People with newly diagnosed type 2 diabetes or high blood glucose levels may be given insulin to maintain their blood glucose at healthy levels. Often these people can be converted to oral medications by the time of discharge if they are only using small doses of insulin in the hospital.
Special Help for Insulin Pumps For those with insulin pumps, hospital factors such as stress, pain, medication, or mental distractions can make it difficult to keep track of things during a hospital stay.
However, many people with diabetes using insulin pumps can still safely use these devices while in the hospital. Nurses can help monitor pump use and double-check the medical record to ensure an accurate dosing schedule. In some circumstances, people with diabetes may be advised not to use their insulin pump in the hospital for safety reasons. These people will receive multiple daily insulin injections instead and can often resume using their insulin pump when discharged under guidance from the health care team.
Nutrition and Diet At home, rapid-acting mealtime insulin is usually taken immediately prior to a meal. In the hospital, people may eat less than expected, so it is sometimes safer to give the mealtime insulin right after a meal and make dose adjustments based on how much is eaten.
People with diabetes preparing for surgery or other procedures may not be allowed to eat or drink. In such cases, the provider may recommend decreasing the level of basal (intermediate- or long-acting) insulin moderately. is held until meals start again, insulin is continued to bring down high blood glucose levels.
Going Home Before leaving the hospital, it is important to discuss any medication changes and create a plan for home-based care. People with diabetes should continue monitoring their blood glucose levels at home and contact their health care provider if these levels are too high or low. The home glucose meter and blood glucose log should be taken to the next follow-up appointment, which usually occurs a few weeks after leaving the hospital. Sometimes, additional medication changes will need to be made.
Watch for Warning Signs at Home! Call a health care provider immediately if blood glucose levels do any of the following:
- Repeatedly drop below 70 mg/dL (3.9 mmol/L)
- Rise above 300 mg/dL (16.7 mmol/L)
- Stay above 200 mg/dL (11.1 mmol/L) for multiple readings in a row
What Does It All Mean?
- Often, medications change when a person with diabetes is admitted to a hospital. For instance, metformin is often held back.
- Some medications, such as steroids, may increase blood glucose readings in the hospital and require the adjustment of insulin doses.
- Insulin therapy is often preferred to oral medications in the hospital.
- People with diabetes should generally receive carbohydrate-controlled diets in the hospital unless there are other considerations.
- Glucose goals may be different when hospitalized compared to glucose goals at home. Often, people with diabetes can return to their home medication regimen upon discharge if they were previously well managed.
- A diabetes management service (including a physician, nurse practitioner, diabetes educator, and possibly a dietitian) may be available in the hospital to help with difficult-to-manage diabetes.
- On discharge, it is important to understand any changes to the diabetes regimen and when to contact a health care provider.
Dr. Rita Kalyani is an Associate Professor of Medicine at Johns Hopkins University School of Medicine in the Division of Endocrinology, Diabetes & Metabolism. She is an active clinician in the Johns Hopkins Comprehensive Diabetes Center. Dr. Kalyani directs the Diabetes Management Service for Johns Hopkins’ Total Pancreatectomy Islet Auto Transplant Program. She is a new member of the DiabetesSisters Board of Directors.
This excerpt is taken from the recently published book “Diabetes Head to Toe: Everything You Need to Know about Diagnosis, Treatment, and Living with Diabetes” by Dr. Rita Kalyani, Dr. Mark Corriere, Dr. Thomas Donner, and Dr. Michael Quartuccio. Published by Johns Hopkins University Press © 2018. Reprinted by permission of the publisher.