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, 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.
What you can do to make your hospital stay safer?
- Make sure you 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 gel 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 infection, 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.
Helpful tips for diabetes patients:
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 understand what your usual blood glucose readings 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 medication list with your surgeon and anesthesiologist, if going for elective surgery, prior to the hospitalization.
Although medication protocols often change during a hospital stay, it is best to share your pre-hospital medication list 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 list with names, dosages and reasons for medications, so there are no questions. Often, patients are admitted to the hospital stating “I take a small blue pill” which is vague and 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 take only one dose of their twice daily prescribed pills since 2 doses “cause side effects” or “cost too much”. You may take less insulin than prescribed because “you are afraid of hypoglycemia” or “hate feeding low blood sugars”. The staff will appreciate your honestly pertaining to your medications and it may save you from additional medication 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 may 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. They record every medication given. Do take the medications offered to you even if they look different after you ask questions. Many hospitals stock generic drugs which usually are 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 are required to have more strict controls. These meters are measured and calibrated daily to ensure accuracy. You could and should compare your meter for accuracy while they are testing but realize they will still use their own results. Remember that home meters can have a 20% error (either higher or lower) than the actual blood sugar number so do not be surprised or upset if you see a large variation.
Sometimes you may be able to have your primary physician, nurse practitioner, internist, or endocrinologist write an order for additional diabetes self-care.
This would depend on your mental and physical condition during your hospital stay. This decision is based on your own 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 with your regular physician but try to understand that hospitalists are there to specifically 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 more specialized in critical care medicine compared to a hospitalist.
What about the staff in big teaching medical centers?
You may be surrounded by nursing students, x-ray tech students, medical students, interns and medical residents, besides your main physicians. Studies have shown, “the more eyes that see you and the more hands that touch you, may lead to a quicker and more accurate diagnosis.” Remember, you do have a right to eliminate access to any students if you are uncomfortable with them participating in your care.
Insulin regimens often change during a hospitalization since blood sugars can be 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 and receive them in different modalities. Often patients are on only one type of insulin at home called long acting insulin which includes Lantus, Levemir, Tresiba, Basaglar or Toujeo. When in the hospital due to elevated blood sugars, they may need to add rapid acting insulin such as Novolog, Apidra or Humalog, prior to your meals. Most times after full hospital recovery, you generally go back to your initial oral medication and/ or insulin regimen.
If you use an insulin pump, you may be disconnected during your hospital stay.
Many hospitals do not have adequate staff specializing in diabetes care who can operate sophisticated pump equipment and do not stock the proper supplies needed for your pump. You will receive multiple daily insulin injections during your hospital 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.
- Reduce your stress levels by meditating, reading or watching TV. Use whatever technique works for you.
- Take all your medications as they are given.
- Keep up your nutrition by eating your meals. Ask for additional food choices which may help increase your appetite without raising blood sugars.
- Drink plenty of water, if not on fluid restrictions.
- Walk in the room or hallway when given permission.
- Make sure to get adequate sleep and rest to promote healing.
Always speak up, 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. Have someone in the room with you for a second pair of ears. Take notes.
When ready for discharge make sure you understand your home discharge orders.
Many patients return to the hospital within 30 days of discharge, since they did not understand the discharge plan; a nurse will meet with you and explain your home plan. This includes when you can shower or bathe, drive, return to a normal diet, do exercise, go back to work and resume your regular medications. Try to have a family member or a friend with you during this information session, so it makes sense and you can follow the proper orders. Call when you get home, if you have additional questions. Make sure you have a follow-up visit scheduled with your physician and that you have all the written medication prescriptions you need to refill.
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 write new prescriptions or refills upon discharge, given to you by the nurse. Fill them in the hospital if you can for convenience. Purchase any OTC products there as well such as Tylenol or Tums, if needed.
Schedule an appointment with your regular physician or surgeon
If you were not given an appointment card for a follow up during your discharge planning, then try to make an appointment as soon as possible. This helps you continue to do what is needed, to maintain optimum health and follow up care.
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.