What Is New In In-Patient Diabetes Care

People with diabetes who receive in-patient care are usually confined to a hospital or other medical setting. It can be difficult to control hyperglycemia in hospitalized patients, especially when they have an infection or surgery. Learn what is new in in-patient care for people with diabetes.

• During hospitalization, the occurrence of uncontrolled blood sugar fluctuations increases. Sometimes hyperglycemia is caused by the stress of being in a medical setting or because of their current medical conditions. Other times, patients may suffer from extreme low blood sugars or hypoglycemia due to eating patterns or need for increased insulin. Recently the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) developed guidelines or protocols for optimal glucose goals for hospitalized patients. The goal is to help clinicians control glucose levels in patients and avoid hyperglycemia or hypoglycemia.
• There are certain obstacles to managing blood sugar levels during in-patient care. These include inconsistent caloric intake, serious illness, uncontrolled infections, and changes from home medications. Another possible factor is limitations of timing of insulin administration and proper glucose monitoring. Blood pressure control is another major concern during in-patient diabetes management. A blood pressure monitor should be used frequently to verify the levels and make sure they remain under 140/80.
• Hyperglycemia occurs when blood glucose is over 140 mg/dl although it may not be treated at that point. Treatment is needed when levels remain persistently higher than 140 to 180 mg/dl. Getting a red blood transfusion can falsely decrease A1C levels. Testing might be done to determine these levels and help doctors develop a more effective diabetes management plan. Glucose monitoring is done before each meal, prior to going to bed and during times of specific problems or changes in status.
• Oral medications may contribute toward hypoglycemia or hyperglycemia including sulfonylureas, metaglinides and Metformin. As a result, doctors have found insulin is the best way to manage diabetes at an in-patient setting. A balanced diet with whole grains, lean meat and fish, vegetables and fruit and low-fat dairy also helps stabilize blood sugar levels. Insulin is more flexible since doses are easily adjusted based on changes in food intake that may occur in an in-patient setting.
• Insulin therapy in an in-patient facility requires flexibility to change with a patient’s condition. An effective method is referred to as a scheduled basal/bolus insulin regimen that is designed to help prevent blood sugar fluctuations. Rapid-acting insulin analogs may help to reduce hypoglycemia when given 0 to 15 minutes before a meal.
• Hyperglycemia is also managed with enteral tube feedings. Lower glucose results are achieved using an enteral formula that includes modified fat content and reduced carbohydrate along with scheduled insulin doses. Tube feedings are handled much like regular feedings with regard to insulin administration. Patients on steroids may need to have increased insulin doses to avoid the risk of hyperglycemia. When patients are discharged, medication instructions are provided and should be followed. Any irregularities should be reported to your health care team immediately. Patient education might be offered to help people with self-management of diabetes. Find out if a diabetes educator, diabetes nurse, and/or dietitian are available during your in-patient stay.
• While hospitalized, the staff will try to get patients to move around each day. Sometimes a physical therapist might coach patients about ways to exercise, including stretches than can be done in bed. Exercise and strength training can help reduce blood sugar fluctuations, relieve stress and help patients recover faster.

Researchers continue to develop effective ways to provide in-patient care and treatment for people with diabetes. Innovative methods help keep blood sugar level in control. Patients enjoy optimum health and are given detailed instructions for self-management upon release.