Management of diabetes in hospital

Guest Post, David Mapletoft, Diabetes Educator

With a safe and effective diabetes self management plan you can reduce your risk of the need for a hospital admission. However, if you do end up in a hospital bed – and it may not be for diabetes – ask to see one of the diabetes team.

Having the diabetes team in your corner is likely to reduce your time in hospital.  Hospital admissions can sometimes be prolonged due to diabetes inadequately managed by non-expert health care professionals. Before admission consider: asking for a copy of the Hospital’s Policy Brochure “Your Rights and Responsibilities” – they should have one.

Managing hypoglycaemia and hyperglycaemia

You can request to see the hospital’s policies for the management of hypo and hyperglycaemia. Ask the treating team of doctors and nurses how this policy will be carried out as a part of your hospital care plan before you enter hospital, or in an emergency, as soon as you or a support person are able.

  • Request that you be able to access your own tools and treatments to manage a hypo. If this becomes a problem ask to speak to the nurse in charge of your ward, or one of the doctors on your treating team.
  • If you are well enough and able to make decisions as usual, request that you be able to adjust your own insulin whilst in hospital.
  • Ask the treating team to prescribe your insulin doses in a manner that allows for this. Ideally you will have some written plan from your endocrinologist for this situation.
  • Following an episode of either hypo or hyper tell the nursing staff how often you want to measure your Blood Glucose Level, or find out what their policy is.

Blood glucose monitoring, including self monitoring blood glucose

Responsibility for monitoring can be shared between you and your hospital team, or managed by either one depending on how well you are and what you want.

  • Request that, if you are well enough, you measure your own BGL’s in a timely manner to aid a rapid recovery.
  • The approach to monitoring should be agreed and recorded in your hospital care plan. You should have access to your own blood glucose monitoring and quality control equipment.
  • If you are self-monitoring you may be asked to record your levels on a blood glucose chart(s)
  • The range and level of your blood glucose levels should be discussed and agreed with you in partnership with the hospital and diabetes specialist teams and recorded in your care plan. Sometimes this range may vary to your usual targets.

Your medications and treatments

If you wish to use your own medications during your hospital stay this should have been agreed and recorded in your care plan. If you are not able to use your own medications your hospital team should ensure that your medications are given to you at the appropriate times.

Unless impractical, ask to be given the opportunity to check that the medications on the prescription chart are correct.

Changes to your diabetes treatments

Not all people will experience a change to their diabetes treatments during their hospital stay. However there may be occasions where a change to your diabetes treatment(s) is required in order to better stabilise your diabetes control. If your treatment is being adjusted, especially if your insulin type is being changed by doctors who are not diabetes specialists, ask what their rationale is, for example

  • If you are normally treated with tablets, you may find that you are given insulin.
  • If you are usually on a mixed insulin and it is being changed to individual doses 4 times a day or
  • If you are normally on individual doses and it is being changed to mixed insulin twice a day or
  • Your overnight insulin is being changed or that you are given a glucose/insulin drip into a vein.

Access to food and food timings

Wherever possible, you should be able to make your own food choices. Whether this be from the hospital menu, the hospital canteen, or food brought in to your by relatives or friends. Ask to see a dietitian wherever possible.

Check what times meals are, and if an evening snack is going to be provided to reduce your risk of overnight hypos. (one of the most common causes of overnight hypos in hospital is an evening snack served with dinner rather than later in the evening).

Depending on the nature of your stay (eg post surgery), a hospital dietitian may need to specify your dietary requirements. You may need some short term changes to aid healing etc.

 

Ask a family member or friend to advocate for you if you are unable to do this yourself

ASK QUESTIONS – IT’S YOUR RIGHT

Travel Safely, David – Diabetes Educator

7 Comments

  1. Imagine_David on February 18, 2014 at 5:34 am

    What’s your experiences and tips for others about diabetes in hospital?

  2. David Barnes on February 18, 2014 at 7:43 am

    I always feel very exposed in hospital. Working 24/7 managing diabetes then going to being cared for by clinical people I feel like I have failed. So what I do is, I surrender. Yep, just for a time I know If I’m in hospital I need help so I let them give it and listen to advice. A tip is to say thankyou to everyone you meet and be as responsive to their questions as best as you can. This helps the care improve even more. Remember to, you don’t have to be a stubborn soldier recieving care in hospital. Staff there Know about diabetes, they know you are a worrier.

  3. catherine on February 18, 2014 at 11:38 am

    i have been in Hospital for heart problems i am t1 & on a pump,i find that they have no idea when it comes to pumps,so i tell them that i will look after my diabetes,they are happy to leave it to me.

  4. Sue on February 18, 2014 at 2:13 pm

    Thankyou for these fantastic tips David!
    i have had some really bad experiences in the past – insulin being withheld in A&E leading to DKA, and insulin being withheld again a few days later in another major public hospital. The miracle of surviving 50 years with t1D is surviving this sort of life-threatening negligence, not the day to day stuff.
    After discussing those experiences with multiple health professionals, I have never got any tips on how to prevent that sort of thing happening again, so thankyou.
    I basically avoid hospitals as much as possible, its part of my motivation to stay well so I can keep a safe distance from health professionals. I did what I could to push for a protocol to be developed and available on the staff intranet, but it went to a committee, so I assume nothing was done – I have not been able to find out. A couple of years ago a dvd was offered to me about how to deal with this sort of situation, but it never arrived.
    I will be looking into your suggestion about getting a copy of the hospital’s brochure on rights and responsibilities.
    Sue.

    • David Barnes on February 18, 2014 at 10:36 pm

      Hi Sue

      Keep your chin up, you are an Old salt and your wisdom is valuable to clinical staff. Everybody learns and needs to update learning and your insights are better than the diabetic who says nothing. Keep believing and stay positive. They will get it eventually. I use my local diabetes Tasmania mob or clinic to assist with heavy lifting issues. Do you?

      • Sue on February 19, 2014 at 12:59 pm

        Thankyou David. I wish I could be as confident as you that “they will get it eventually”. My GP’s comments were that “they employ the cheapest staff” (i.e. least qualified/experienced) and that “others have had worse outcomes” (they died).
        I went through the Health Complaints Commission, and the advocacy officer at my local branch of Diabetes Australia. The HCC does not keep records, so can’t tell me the outcome, and the local DA branch no longer has an advocacy officer, and told me last year they have no intention of filling the vacancy. Disappointing, because I think advocacy is one of the most important things they could be doing.
        Cheers,
        Sue.

  5. Imagine_David on February 19, 2014 at 4:10 am

    Thanks for your contributions David and Sue.

    This may be one important issue to put on the list of things you’d like to work on with your endocrinologist.

    Regards,
    David

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