During any given year, 1-out-of-every-4 Americans with diabetes will spend a day or more in the hospital. As a person with diabetes, you are likely to be admitted to the hospital because you are more at risk for heart, circulatory or kidney disease or a variety of infections. Oftentimes, hospital staff focus so much on taking care of the main reason for the hospital stay, that good diabetes care becomes an afterthought. Here is how the experts believe your diabetes should be taken care of in the hospital.
HIGH BLOOD GLUCOSE
Experts have found that having high blood glucose levels while in the hospital may actually worsen the very condition that brought you into the hospital. High blood glucose levels may make any medical problem even worse. High blood glucose levels during a hospital stay may make the healing process take longer. One study looked at people with diabetes who were in the hospital because they had a heart attack. The study found that these people were more likely to increase problems, delay healing and even increase the chance of death if their blood glucose levels were out of control.
NEW ADVICE
Two large organizations that set standards of care for people with diabetes-the American Diabetes Association and the American College of Endocrinology-joined forces to publish advice on how people with diabetes should be cared for in the hospital. A strong push was made for blood glucose levels in the hospital to be as close to normal as possible. The organizations found that this reduces complications and infections, saves lives and shortens the length of hospital stays for people with diabetes.
INSULIN WITH OR INSTEAD OF PILLS
Even if you usually take diabetes pills to control your blood glucose, your health care provider may decide that you also need insulin to control your blood glucose during your hospital stay. The reason? Pills won't be strong enough to lower your blood glucose to a healthy level in this situation. You may have had surgery or other medicines that could cause your blood glucose to rise. You might have an infection that causes your blood glucose to rise. You might need a type of test for which you must be off of your diabetes pills for a short time. It is also important to know that certain medicines, such as metformin (Glucophage), can lead to complications if continued during your hospital stay during which heart or kidney function become impaired. Some hospitals have begun to give people insulin through an IV (intravenous). This is given through a device called an insulin infusion pump. It delivers insulin directly into the blood stream slowly and continuously over time. The goal is to help people get the best blood glucose levels possible.
If you need insulin while in the hospital, your health care providers will select the types and amounts of insulin you need based on your situation. You may go back on your pills before you get out of the hospital or you may need to go home on insulin.
AVOID LOW BLOOD GLUCOSE LEVELS
When you are in the hospital, it also is important that your blood glucose doesn't go too low. Low blood glucose (hypo-glycemia, below 70 mg/dL) results when too much insulin or other blood glucose-lowering medicine is used or if meals are delayed. When you are in the hospital, your blood glucose will be checked often with a meter that is similar to the one you use at home. If you are able, be aware of the insulin doses you get and ask about your blood glucose monitoring results. You may want to have your own blood glucose meter with you to check your blood glucose when you want to. Your knowledge of your blood glucose level and how it's being treated will help your health care provider create a treatment plan that will best control your blood glucose during your hospital stay. It is your right to expect the health care providers caring for you to include you in decisions about your diabetes care.
THE BOTTOM LINE
Keep your blood glucose as normal as possible when you're in the hospital. This can lead to fewer days in the hospital with fewer problems and a speedier recovery. When you're in the hospital, experts recommend that your blood glucose levels stay higher than 70 mg/dL and lower than 180 mg/dL. If you are unable to keep a watch on your results, make sure a family member or person who is helping you does so. If possible, talk with your health care providers before you are hospitalized and while you are in the hospital, and let them know about your concerns. Plan ahead, be informed and be prepared.
