Introduction
A patient’s admission to hospital may or may not be directly related to their diabetes. While in hospital diabetes management should be shared between the patient (or relatives and carers) and the ward / specialist team. Good diabetes control in hospital is important for a speedy recovery and early discharge.
Diabetes LIFELINE*
My Diabetes - I trust you to-
LIsten to me; I know my diabetes
Fully complete the green Diabetes chart and follow the guidance available. This keeps me safe
Ensure all my medications are reviewed and correctly prescribed
Look and check my feet daily – I do not want to leave with a heel ulcer
Insulin can be dangerous; errors can be fatal – Follow the 6 R’s
6 R’s Right patient
Right insulin
Right time
Right route
Right dose
Never abbreviate units to “u” or “iu” – I do not want a 10x insulin overdose.
If I have type 1 diabetes do not stop my insulin – I do not want to develop DKA
Never ignore my blood glucose level; regularly review my chart –I do not want to suffer a hypo - or hyperglycaemic crisis
Ensure my discharge letter is complete – review medication and insulin changes, I do not want to be re-admitted.
My LIFELINE to safe diabetes care – if you are unsure how to look after my diabetes ask for help
*adapted from original Diabetes LIFELINE document by Prof Gerry Rayman (Ipswich Hosptial)
What care to expect when you are in hospital
The following information is for all patients with diabetes who are admitted to hospital:
Receive a full explanation of your treatment during your stay in hospital and have the opportunity to discuss any particular worries. If you do not receive an explanation, please ask for it.
Inform the ward team of your usual diet, tablets, diabetes medication or insulin treatment. Bring your own supplies with you. If they are removed for safe keeping, make sure that they are returned to you at the end of your stay, or if you move from one ward to another.
Where necessary or at your request the healthcare professional looking after you should refer you to the appropriate member of the diabetes care team (doctor, nurse, podiatrist). Have your diabetes (blood glucose levels and treatment) reviewed daily.
Have your feet checked daily.
Discuss your diabetes with the hospital team so you can manage some aspects of it yourself, such as blood monitoring and injections, if appropriate. However the staff may need to check your technique and results and they may need to do additional tests of their own.
If you are treated with insulin, expect that it may be given by an infusion pump/drip into your vein if for some reason you are unable to eat or drink. If you are having an anaesthetic or are required to fast prior to a procedure then the care of your diabetes will be managed by the anaesthetist and medical team during and after the procedure.
Any changes to your treatment should be discussed with you.
If you think you are experiencing a hypo whilst in hospital please inform the nurse or doctor immediately to allow them to administer treatment quickly. If you have treated an episode of hypoglycaemia yourself in hospital please let staff know what your blood sugar was if you were able to check it and also how you treated it - as we like this to be recorded in your medical notes.
Expect to be informed and consulted about any changes in your treatment or diet which may be necessary during your stay in hospital. For example, people with type 2 diabetes are sometimes treated with injections of insulin for a short while whilst in hospital. This is because their illness or operation has upset their diabetes control.
Expect staff to plan your discharge early during your admission. They will consider any
changes to your diabetes treatment, referral to the diabetes team, communication to family, carers, GP, practice nurse, district nurse. Your discharge plans should be discussed with you and your relatives / carers. Once your condition is treated your diabetes should not be a reason for you to stay in hospital and if this is the case you should be referred to the diabetes team for review.
If you are unsure about the treatment or diet you are receiving in hospital, speak to your doctor or nurse. If you have concerns about your medication, you may also speak with the ward pharmacist.
Meals and snacks
Medication and food should be given at the right time. Access to food and snacks can help to enable good diabetic management and reduce the incidence of hypoglycaemia.
Choosing from the Hospital Menu if you have Diabetes:
If you are in hospital and you have Diabetes, this is some guidance to help you choose appropriate foods from the menu.
Most people who have Diabetes are encouraged to choose a ‘healthy diet’, similar to the one also recommended for the general population, which is low in fat, salt and added sugar. The healthy options are highlighted on the menu you are given whilst in hospital with a heart symbol. The symbols are found next to the meal, dessert or snack.
Remember to also think about these important points to ensure that you have a healthy diet for your diabetes while you are in hospital.
Regular Meals:
Eating three meals a day - breakfast, lunch and the evening meal while you are in hospital. If you have been advised to have snacks in between meals for your diabetes, these can be provided on the ward (ask the hostess).
You should be able to keep these snacks at your bedside.
Ask friends and relatives to bring in sugar free drinks or squashes, so that you can have these on your bedside cabinet.
Try to make sure that you have some starchy food at each meal: e.g., cereal, bread, rice, pasta, potatoes.
There are some times that following a low fat, low sugar diet is not appropriate, and you may be advised to choose the higher calorie and protein menu choices and snacks eg, if you have a poor appetite, if you have lost weight unintentionally or you are on some modified diets.
If you or the team looking after you have any concerns regarding managing you diabetes when choosing these menu options in hospital, this can be discussed with the diabetes team.
Managing Hypos
Expect to be able to manage your own emergency supplies of sugary drinks, biscuits, fruit or glucose tablets to treat hypoglycaemia. If you are on insulin or sulphonylurea tablets (gliclazide, glimepiride) you (or your relatives or carers) should bring these snack supplies with you if possible. Please do not leave food uncovered by your bedside.
If you do experience a hypo please inform the nurse or doctor immediately. Let them know what your blood sugar was if you were able to check it and also, if you treated the hypo yourself, what you treated the episode with, as we like this to be recorded in your medical notes
If you do not have your own hypo treatment with you, there is an emergency hypo box available on the ward.
Carbohydrate counting
If you have type 1 diabetes and you count carbohydrate, you can ask the ward staff to provide you with the carbohydrate values of the menu choices.
Self-administration of Insulin
There is national guidance on the Self Management of Diabetes in Hospital
Acute Trusts will have developed their own individual guidance and it is important to familiarize with local guidance.
Currently in UHL the document below summarises clearly guidance on self-administration of insulin (see UHL bulletin).
FINALLY: Remember to listen to your patients and their carers or family – they are usually the experts on managing their diabetes