Plan Before You Go
An admission to the hospital -- whether for a planned procedure or an emergency -- adds extra challenges to diabetes care. Illness, stress, or surgery, plus changes in eating and sleeping routines, can wreak havoc on blood glucose levels. "Whatever you were doing at home probably will not work in the hospital," says Jane Jeffrie Seley, N.P., BC-ADM, CDE, a diabetes nurse practitioner at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. That's why it's crucial to have a plan.
Get your blood glucose under control.
Marcie Draheim, R.N., CDE, former president of the American Association of Diabetes Educators, advises reining in blood sugars at least a month before a scheduled procedure. "It's not a good idea to come into surgery with high blood sugar," she says.
Provide your recent A1C test results.
The A1C test reveals blood glucose control over the past two to three months. It also gives the hospital staff a better idea of how much insulin you'll require during your stay and any medications you might need when you go home. "I use it as an indicator of whether or not the diabetes treatment before the illness was working," says diabetes nurse practitioner Jane Jeffrie Seley. "If the A1C was elevated above 7 percent on admission, then we need to provide a more aggressive regimen for home."
Explain your symptoms of hypoglycemia, if you experience it.
Low blood glucose isn't a worry for every PWD, but if you tend to have frequent or severe lows, tell the staff. Describe signs of your lows -- sweating, irritability, etc., or none. Some people prone to lows have no symptoms, especially if they've had diabetes for many years.
Know your medications.
Carry a complete list of the medications and supplements you take, including dosages and frequency. Alert your providers to any allergies or previous reactions to medications. Your provider may advise you to temporarily stop taking some types of blood glucose-lowering medications while in the hospital to avoid conflicts with other treatments. Drugs that are filtered by the kidneys, such as metformin, may need to be discontinued for a time.
You may need to take insulin to control blood glucose during your stay because of changes in your normal regimen or because of added medications or procedures. Steroids, for example, can cause high blood glucose.
Be prepared to use the hospital's monitoring supplies.
Hospitals need to know that the equipment used to measure blood glucose is accurate, safe, and clean. For quality control, a hospital should use its own meter and strips, says Robert Cuddihy, M.D., medical director of the International Diabetes Center at Park Nicollet in St. Louis Park, Minnesota.
Make plans if you use an insulin pump.
Some hospitals welcome the use of a pump, but others don't. "You have to assume that most doctors and nurses don't know how to use a pump," Cuddihy says. "People with type 1 diabetes with good control need to ask: Will I be fully conscious? Can I regulate my pump at all times? What does the hospital allow?" If you're in poor control, the staff will probably put you on injections of insulin. If you do want to use your pump -- and you're able to manage it yourself or have caregivers who can -- make sure to take plenty of supplies to the hospital.