I often counsel patients in the diabetes self-management sessions that have recently encountered a scary experience during a hospital stay. Although they may be admitted through the emergency department(ER) for an acute problem, are scheduled for an elective surgery or are admitted for an unrelated illness, they still have diabetes and it must be treated correctly. Generally when arriving at the ER, the first question asked is “do you have diabetes”? This is because it is such a common condition and because there are more critical issues related to diabetes. Since blood sugars must be controlled even during an acute illness, I thought it was important to share information about being in the hospital when you have diabetes this way you can have a successful encounter which should not be scary!
Make sure you actually see each hospital employee giving you care wash their hands. Current research confirms this is the easiest and safest way to stay healthy during a hospital stay. If you have not physically seen them washing, feel free to ask if the staff washed their hands and never feel intimidated by asking. It is also critical to carefully wash your own hands often during a hospital stay. Use regular soap and water instead of antibacterial soap when possible. Bring a pack of bleach wipes and wipe down your phone, nurse button, TV control, bedside stand, bed rails and IV pole. These small measures may help prevent an extremely difficult problem frequently found in hospitals called C-diff (Clostridium difficile infection) which causes severe diarrhea and stomach issues. Many patients end up with a chronic form which should be prevented at all costs. Below are a few more tips:
Share your previous A1C values and diabetes numbers with the hospital staff.
Unfortunately when the body is suffering with an illness or infection, recovering from a procedure or surgery or taking steroid medications because of a different condition, the blood sugars can soar. The hospital staff should have an understanding of what your usual numbers are for reference. It is extremely important to get sugars under control as soon as possible to allow for complete healing for any condition requiring hospitalization. Most hospitals now have a specific diabetes team including an endocrinologist, a diabetes nurse educator, a dietitian well versed in patients with diabetes under physical stress and a pharmacist who understands all regular diabetes medications interacting with any newly prescribed medications.
Share your diabetes and other medications with your surgeon if going for elective surgery prior to the hospitalization.
Although drug protocols often change during a hospital stay, it is best to share this information prior to admission so it can be noted in your hospital record. You should also share this information with the hospital staff including the admission nurse. Always bring a complete written record with names, dosages and reasons for medications so there are no questions. Often patients are admitted to the hospital saying “I take a small blue pill” which is very unhelpful to the staff. If on insulin, be very specific about the timing, correct dosage, how it is delivered – syringe, pen or pump – and the correct type of insulin. Be completely honest about how you currently take your medication not only how it is prescribed. Some patients only take one dose of their twice daily prescribed pills since 2 doses “cause side effects” or less than the insulin dosage prescribed because “they are afraid of hypoglycemia”. The staff will appreciate your honestly pertaining to your medications and it may save you from additional dosing problems and complications.
Understand that most hospitals will not allow you to take your own diabetes medications while under their care.
They will take charge and if you continue taking your medication you will be over-treated. Hospitals are afraid you may not be able to time the medication properly or remember the medication due to reduced mental acuity from a surgery or infection during your stay. Do take the medications offered to you even if they look different after you ask questions. Many hospitals stock generic drugs which usually act the same but look different due to costs and specific price contracts. Do not be afraid to ask or to speak up.
You will not be allowed to test your own blood sugar with your home meter.
Many patients feel most comfortable with their own meter but hospital meters have more strict controls. They are measured daily to ensure accuracy. You should compare your meter for accuracy while they are testing but realize they will use their own results. Remember that home meters are allowed to have a 20% error (either higher or lower) than the actual blood sugar number so do not be surprised if you see a large variation.
Sometimes you may be able to have your primary physician/internist/endocrinologist write an order for additional diabetes self-care.
This would depend on your mental and physical condition during your hospital stay. This is for your safety.
Most current hospitals supply a hospitalist who usually specializes in all aspects of internal medicine.
Your private physician may no longer carry hospital privileges or may be too busy to attend the hospital due to their daily outpatient volumes. It may seem strange and difficult to deal with a new MD during a crisis, especially if you have a very close relationship to your regular physician, but try to understand they are there to help you during your hospital stay. When in the critical care units such as the ICU, CCU, PACU or SICU, you may see an intensivist who is even more specialized in critical care medicine compared to a hospitalist.
Insulin regimens often change during a hospitalization since blood sugars are often more elevated during an illness.
You may hear the words “sliding scale” which means you may receive different amounts of insulin with each injection. You could require different types of insulin. Often patients are on only one type of insulin at home called long acting which includes Lantus, Levemir or Toujeo. When in the hospital due to elevated sugars, they may need to add rapid acting insulin such as Novolog or Humolog prior to your meals. Most times after full recovery, you generally go back to your initial medication and or insulin regimen.
If you use an insulin pump, you are often disconnected during your hospital stay.
Many hospitals do not have staff that can operate this sophisticated equipment and do not stock the proper supplies needed for the pump. You will receive multiple daily insulin injections during your visit and return to the pump when back home.
Do your best to keep blood sugars controlled during your hospital stay to help lower the risk of infections or complications to have a speedy recovery.
This means trying to reduce your stress, take all your medications, keep up with your nutrition as well as ambulating when given permission.
Speak up at all times since no one knows your diabetes as well as you. You may not know all the medical lingo but you do know how you feel.
Ask questions until you are satisfied and really understand the answers.
When ready for discharge make sure you understand your home discharge orders.
This includes when you can shower or bathe, drive, eat a normal diet and resume your regular medications. Try to have a family or friend with you during this training so it makes sense and you have no additional questions when you get home.
Try to visit the outpatient pharmacy often located in the hospital so you do not need to make additional stops on your way home.
The physician will usually hand you new prescriptions or refills upon discharge. Get any OTC products there as well such as Tylenol or Tums if needed.
Schedule an appointment with your regular physician.
Try to do this as soon as possible to make sure you continue to do what is needed to maintain optimum health.
Going to the hospital for any reason can certainly be a frightening experience. When you have time to plan, try to take these steps to make the experience as pleasant and safe as possible. If admitted during an emergency, try to have an advocate to help protect you. Diabetes can be an additional risk while in the hospital. Being prepared will certainly be an advantage to keep you as healthy as possible. Good luck!
Always feel free to email me your questions at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.