While you're in the hospital, many factors will affect your blood sugar levels. It could be the illness for which you're being hospitalized, the treatments you receive, physical and psychological stresses, various drugs and IV fluids or a changed meal plan; any of these variables can cause unpredictable, potentially dangerous fluctuations in blood sugar levels.
Keeping yourself and the hospital staff informed and maintaining good communication are vital components to a successful and safe hospital stay. Some of the most commonly asked questions by people with diabetes who are about to enter the hospital are as follows, with answers to provide information to help you prepare for your stay.
Why Is It So Important to Control My Blood Sugar in the Hospital?
Excessive glucose levels slow the healing process and boost the risk of infection. Tight diabetes control around a surgery has been shown to reduce illness, shorten hospital stays and even lower the risk of death.
Will My Blood Sugar Target Levels be Different During the Period That I'm Hospitalized?
Yes, it is possible that target blood sugar levels may be different while being hospitalized. The American Diabetes Association recommends keeping blood glucose levels below 180 mg/dL while in the hospital. However, individual circumstances vary. For some patients, the recommendation is to keep blood glucose levels below 110 mg/dL.
Will I be Able to Control My Own Blood Sugar Levels in the Hospital?
Controlling your own blood sugar levels during hospitalization will depend on several factors such as hospital policy, the reason for your hospitalization and your physical condition. Be sure to ask your doctor for a "self-management order," a document that will permit you to take care of your own testing and management if you are capable during your hospitalization.
Even if you are able to apply self-management while in the hospital, you may be required to use supplies that the hospital provides. Be sure to ask the hospital's diabetes educator about this before you arrive.
If I Can't Control My Own Blood Sugar During My Hospitalization, Who Will?
You have a right to have your own diabetes doctor or care team monitor and maintain your blood glucose levels. Ask your doctor whether or not it is recommended. If so, be sure to inform the hospital's diabetes educator to make proper arrangements.
If your personal care team won't be participating, ask for clarification about which staff members will be responsible for your blood glucose management. Make sure these people know your unique symptoms of low and high blood sugar levels.
Will the Hospital be Able to Accommodate My Particular Eating Plan?
Some diabetics have to be very careful about when and what is eaten. In these cases, patients need to make sure that the hospital dietitian has a copy of your diet plan well in advance of your arrival. Don't be shy about reminding hospital staff if meals don't show up at the proper times or if they don't incorporate the right foods.
Will I be Able to Take the Usual Snacks I Use When My Blood Sugar Drops?
You may be able to possibly use your own usual snacks when blood sugar levels drop, but glucose pills are used more often in a hospital setting.
How Will Medications I Receive in the Hospital Affect My Blood Sugar?
The affect of the interaction of other medications on blood sugar levels may depend on many factors, which include whether or not a patient is taken off normally used medications for some period of time while being hospitalized. Talk to your doctor or diabetes educator for more specific information on the medications you will be taking.
If I Am Given Insulin During My Hospitalization, What Should I Expect Since I Usually Don't Take Insulin?
Sometimes insulin is given to hospitalized patients with type 2 diabetes who do not usually use it as a way to temporarily control blood sugar levels when usual medication, diet and exercise control regimens are disrupted. Insulin may be administered before, during or after surgery. Insulin is often administered through an insulin drip, or medical staff may give insulin through an injection.
Can I Take Low-Dose Aspirin Before Surgery That I Usually Take to Reduce My Heart Risks?
Because aspirin blocks platelets which are responsible for forming blood clots, most patients are taken off aspirin and other blood-thinning drugs, such as warfarin for several days before surgery. Usually five days is a commonly used cutoff. For aspirin, 5 to 10 days may be recommended, depending on the surgery to be performed. In the case of coumadin, patients may also be placed on an injection blood thinner while waiting for the effects of the coumadin to "wash out". Be sure to check with your diabetes care team and surgeon well in advance before you arrive at the hospital.
How Will Anesthesia and Surgery Preparation Affect My Blood Sugar?
Patients with diabetes are often taken off their glucose control medications the night before surgery. Often, as with most patients preparing for surgery, those with diabetes must also fast and refrain from drinking fluids before surgery. For this reason, people with diabetes are often scheduled for surgery early in the morning to limit the amount of time they are off their medications. Discuss this option with your diabetes care team and surgeon.
How Can I be Sure My Doctor Communicates With My Surgeon?
The two key people who will facilitate communication are your diabetes doctor and the hospital's diabetes educator or diabetes care coordinator. Both are experienced in dealing with hospitalized patients with diabetes. When you first contact the hospital's diabetes educator, tell this person that you want to speak with your surgeon and anesthesiologist before the surgery and request a a full preoperative evaluation. This should not be a problem: Preoperative evaluations are a standard part of surgical planning. Prior to operating, surgeons routinely require a thorough evaluation that includes diabetes management planning.
How Do I Make Sure That all of the Hospital Staff Who are Involved With My Care Know I Have Diabetes?
Of course, your diabetic status will be reflected on your medical chart, but don't hesitate to remind nurses, doctors and other staff that you have diabetes. Ask if you can wear your usual diabetes ID, which can provide another level of awareness for the hospital staff.
Keeping your primary doctor's contact information, a list of any medications you are currently taking and an allergy history handy in your wallet in case of an emergency will help the physicians caring for you become familiar with your medical history quickly.
A hospitalization is stressful for anyone, even moreso for someone with diabetes. Be assertive, be clear and be sure to have family, friends or your diabetes care team there to advocate for you.