Diabetes: What To Do If Hospitalised

I found this article in dLife and having undergone surgery twice, I can see why the author Therese Garnero stresses the need to manage hyperglcemia. In my case I was in hospital for 50 days all because I had high BS. Unfortunately the hospital’s endocrinologist failed to manage my sugar levels.

Facing surgery is a scary prospect in and of itself. For people who have never taken insulin, the thought of needles only adds to the fear. Plus, if you have heard some of the endless stories and myths circulating about insulin, it only makes matters worse.

You want to go into surgery feeling as confident and relaxed as possible, with minimal anxieties. I hope that after you read this column about the enormous negative impact high glucose levels (hyperglycemia) have on people who are hospitalized, and the incredible benefits of insulin, you’ll feel a little less nervous.

Imagine being hospitalized with a fever of 103 degrees and the hospital staff doesn’t give you any (or not enough) medication to reduce it. Too often, that is the case for people with hyperglycemia—it goes untreated, under-treated, or worse—undetected.

Until recently, it was felt that mild to moderate hyperglycemia didn’t really matter. Now we know better. The research evidence points very strongly to the importance of maintaining tight control of glucose levels when hospitalized. Meticulously controlling glucose improves recovery from illness, reduces mortality (death rate), post-surgical infections, and the length of time spent in the hospital—definitely good things!

How high is high? According to recommendations made by the American Diabetes Association (ADA) Diabetes in Hospitals Writing Committee, glucose levels should be maintained as follows:

# In the Intensive Care Unit (ICU), less than 110 mg/dl (6.11 mmol/l) at all times

# In non-critical care units (like the medical-surgical units), less than 110 before meals, and a maximum of 180 mg/dl (10.00 mmol/l)

# The lower limit for all areas, 80 mg/dl (4.44 mmol/l)

I first learned about these new national standards at the 2004 American Association of Diabetes Educator conference. I was, and still am, outraged. Did you know that at least 25% of all hospitalized adults have hyperglycemia and/or undiagnosed diabetes?

What can you do to combat hyperglycemia if you find yourself in your neighborhood hospital?

Inform the staff. Make sure they know you have diabetes.

Ask to have your glucose level taken regularly (typically done before meals and at bedtime, and more often based on values). I am amazed at how often glucose levels are not checked.

Bring your glucose monitor to the hospital. Some people find comfort in knowing they can check their glucose on a moment’s notice. Plus, if you feel up to it and the hospital allows, you could check your glucose as ordered by the doctor instead of using the hospital’s system (which can have painful lancets).

Realize that insulin is your friend. It has only been around since the 1920s. The Portland Protocol, which is a new national standard for insulin use in the hospital, is placing all people going into surgery, whether or not they have diabetes, on a low dose insulin drip because of its benefits.

Know that it is normal to be afraid of needles, at first. If you liked needles, we’d worry! Trade secret: the new insulin needles come in short, skinny sizes, and oftentimes hurt less than poking your finger with a lancet. For some, insulin might be needed for a short time during a hospital stay. For others, insulin is needed long term to keep glucose levels in check. Insulin is one of the best things we have to help control diabetes. It is not the problem—high glucose levels are the problem.

Request your surgery be done in the morning. If your surgery is later, your glucose levels might be harder to control. Even one reading above 200 can have an impact. Ask the surgical team (nurse, surgeon, physician, and/or anesthesiologist) about your medications for the day of surgery. Some medications should not be taken; others are split in half.

Bring an advocate. Who knows a lot about your diabetes and can stand up for you if need be? Studies show it is not uncommon for doctors and nurses to have a basic lack of knowledge and understanding about diabetes. You may have more knowledge about the best way to control your diabetes, but may be too ill to articulate that. So have a family member or friend step up to the plate.

Ask to see a diabetes educator. Not all hospitals have registered nurses, registered dietitians, and pharmacists who specialize in diabetes, but many do. If you need an advocate, a diabetes educator will do just that. You can also ask for an endocrinologist evaluation (a doctor who specializes in diabetes) if your diabetes is not in control.

Control pain. The old adage, “No pain, no gain” is hogwash. Pain raises glucose levels and interferes with healing. Try not to be tough. If you are in pain, let the nurse know.

The best place to play jeopardy is outside of the hospital. Ready? What can double the amount of time you spend in a hospital, increase your risk for a heart attack or stroke, increase your chance of an infection, or increase your chance of leaving this planet forever? Hyperglycemia!

You can minimize your risks and concerns by controlling hyperglycemia in the hospital setting. And luckily, advocates are there to help.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Thank you Theresa Garnero

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