Preparing for a Hospital Stay

Whether in the hospital for an illness, a planned surgery, or for a diabetes complication, having good blood sugar control while there facilitates healing, and lowers the risk of infection.

You can help ensure good diabetes management while hospitalized by maintaining stable glucose levels in the weeks prior to your stay, and by consulting closely with your care team and the hospital staff.

Questions To Ask

Since each hospital has their own policies related to diabetic patients, you will want answers to the following questions before checking in for treatment.

1. Who is responsible for controlling the patient’s blood sugar level while in the hospital? If the patient remains responsible who will take over if he or she becomes incapacitated?
2. Will the patient be allowed to self-monitor? If the answer is yes, the patient should get a “self-management order” (instructions) from the doctor to follow during the stay.
3. How will hospital treatments, procedures, or medications affect the patient’s blood sugar level?
4. Will the patient be given insulin while in the hospital? (Sometimes diabetics that do not normally take insulin are prescribed it while in the hospital.)
5. If the patient wishes his or her own diabetes doctor or team to monitor their diabetes during hospitalization, what arrangements need to be made?
6. While the patient is hospitalized, what is considered the proper blood sugar level? (The American Diabetes Association recommends hospitalized individuals maintain glucose levels below 180 mg/dL, unless circumstances indicate otherwise.)

General Preparations

The hospital staff should know in advance about your diabetes and what your present level of glucose control is. For instance, giving them your most recent AIC result and reporting any current blood sugar fluctuations are helpful. Let them know what your signs of low blood sugar are. Your experience with managing diabetes during any earlier hospitalizations will be useful as well.

Make sure the hospital dietician knows your meal plan before you arrive, including any special preferences or needs. If the hospital has a diabetes educator utilize him or her. Make sure at least one friend or family member who knows your diabetes history will be available to advocate for you, if necessary.

You can ask about using your own glucose meter and drugs while in the hospital, but most places expect patients to use medications and supplies provided by the hospital. This is usually for quality control reasons.

Insulin and Medications

The surgeons, physicians, and nurses giving you direct care should know of your diabetes medication regimen, especially details about insulin dosing. It is important to be honest about how strictly you follow your medication plan while at home—so you are not overmedicated by the diligent hospital staff. Ask about all the medications you are on to see whether they should be continued during the hospitalization.

If you have an insulin pump, check with the hospital to see whether they allow its use. Many hospitals put pump patients on an injection regimen during the stay. Hospitals do not always stock pump supplies, and there may be concerns about a patient’s ability to maintain the pump during the entire hospitalization. The staff will need your pump setting information for the switch to insulin, including the 24 hour basal amount, insulin sensitivity factor, and insulin to carbohydrate ratio.

Those scheduled for surgery should discuss with the doctor what insulin dose to take the night before, and the day of the procedure. Surgical patients taking Metformin are typically told to not take the drug 48 hours prior to surgery, and 48 hours post surgery, lowering the chance of lactic acidosis—see what your surgeon recommends. Ask about all the medications you are on to see whether they should be suspended during the procedure.

Sources: NIH; Diabetes Self Management; Diabetic Living Online
Photo credit: / flickr creative commons