Admission to Hospital

Welcome to York and Scarborough NHS Hospitals Trust.  The Inpatient Diabetes team are available to help you with any diabetes related queries during your stay.

How might your Diabetes be affected by the hospital environment?

Being in hospital can affect your diabetes control considerably.  Blood glucose levels can be affected by many factors and you may find that you experience either higher or lower blood glucose levels- or indeed a combination of both!

The following box indicates just some of the many influencing factors:

Being Unwell	Change in appetite
Physiological Acute Stress Response	Difference in food types
Delay in receiving Glucose Lowering Medications such as Insulin	Difference in size of meals
Sleep deprivation	Difference in proportion of carbohydrate content
Infection	Timing of insulin administration ( particularly around mealtimes)
Steroids	Alterations in timing of meals
Increased/decreased activity	Starvation for procedures or surgery
Stress

 

Monitoring Your Blood Glucose in Hospital

Routinely blood glucose levels will be checked a minimum of 4 times a day, (before meals and before bed) for a minimum of 48hours (depending on your length of stay).  The frequency of blood glucose monitoring is then reviewed and will depend on your individual circumstances.

Blood glucose monitoring is done using the hospital COBAS machines so that staff can upload the range of results and look for any patterns or trends.

It is useful to mention to staff if your current blood glucose control is significantly different to usual.

Staff are happy to discuss your blood glucose levels - just ask.

Can I measure my own glucose levels?

Yes, you are free to use your own blood glucose monitoring devices in addition to the routine monitoring.  For consistency, we need to have a range of blood glucose tests done using the hospital system.  This data is then uploaded onto a chart for review.

Can I use a Libre or Continuous Glucose Monitoring device?

Some people will be used to using continuous glucose monitoring devices such as Libre.  Within the hospital environment we would advise using them as a trending guide only.  These systems monitor interstitial (rather than blood) glucose and during illness the difference between blood and interstitial glucose levels can be variable.   For this reason, any readings out of range must be confirmed using the hospital blood glucose monitor.

 

Low blood Glucose (hypoglycaemia) management in the Hospital setting

Patients are generally at a higher risk of hypoglycaemia when in hospital.  Glucose lowering medications such as insulins, Gliclazide or Glimepiride may need temporary dose adjustment, particularly when dietary intake is reduced.   Should you notice that your blood glucose levels are lower than normal, it is important that you mention this to staff so that medications can be adjusted to prevent hypoglycaemia from occurring.

If you have any symptoms of hypoglycaemia it is important that you alert staff immediately.

 

Staff are trained to confirm hypoglycaemia, administer short-acting glucose, usually in the form of a glucose drink, or as an intravenous infusion if appropriate, and to check response to initial ‘rescue’ treatment.  This may be repeated a number of times if required.  Once blood sugar has increased to above 4mmols, staff will encourage you to eat a food containing a longer-acting carbohydrate in order to maintain the blood glucose level moving forward.  It is important that all glucose lowering medications are reviewed after a hypoglycaemic episode and that the potential cause for the ‘hypo’ is considered.

Access to Food in Hospital Your dietary intake in hospital is likely to be different.  This will directly affect your blood glucose control.  Food out of hours After a procedure Snack box 3  meals a day

High Blood Glucose (Hyperglycaemia) management in the hospital setting

It is common to have higher than usual blood glucose levels when unwell.  Stress, pain, infection and trauma (amongst other things) are commonly responsible for causing this increase.  It is useful to inform staff what your usual blood glucose range is, and also to tell them if you are experiencing any signs or symptoms of high blood sugar (hyperglycaemia).  These might include passing more urine, feeling dry and dehydrated, or unusually tired or lethargic.  It is also possible to suffer blurred vision when blood glucose levels change quickly.

Treatment of hyperglycaemia is dependent on the circumstances.  In most cases, a simple dose increase to your glucose lowering medication will suffice however on occasions it may be necessary to introduce a different medication or to use an intravenous insulin infusion for a small period of time.  It is possible that staff may request to take additional blood sampling.

 

Steroids and Blood Glucose

Steroids can be prescribed for a range of conditions, and for some people this will directly affect blood glucose control.  Steroids can increase the amount of glucose produced by the liver and in Type 2 Diabetes, may affect the amount of insulin naturally produced by the body.  High blood glucose levels might require temporary increases in your glucose lowering medication for the duration of steroid therapy only.  The medication would then need to be carefully reduced again as steroid doses are reduced /stopped.    

Can I manage my own insulin in hospital?

Yes- We would encourage you to maintain independence in administering your own insulin whilst in hospital.  In some ward areas, you may be asked to store your insulin in a locked drawer.  Please communicate with your nurse so that you have access to the insulin at the right time, for example insulins designed to be administered just before, or with, food.

 

Continuous Subcutaneous Insulin Infusion( CSIII) Pump use in Hospital

For any patients who are on a Continuous Subcutaneous Insulin Infusion CSIII (Insulin Pump), it is vital that you bring in adequate supplies for pump changes.  The hospital has limited stocks pump supplies.  It is essential that you inform staff if you do not have the kit available so that the Diabetes Nurses can support you in accessing appropriate equipment.

You are expected to completely self-manage your pump, as ward nurses are not trained to support with these.  If at any stage you feel unable to self-manage, or you become too unwell, the pump will be disconnected and alternative insulin regimen will be given.    The pump is always resumed promptly when safe to do so.

Discharge from Hospital

Checklist:

• Please ensure you are aware of any changes to your glucose lowering medication. The type of medication and dose may have changed or altered.  Discuss this with your discharging nurse or doctor
• Please consider increasing blood glucose monitoring for a few days until you are happy that your levels are stable. If you are unsure of your blood glucose target range, please discuss with staff.
• For ongoing support with your diabetes and for assistance with titrating medications, please contact either your GP/Practice nurse or if under Specialist Diabetes Care, contact your team.

 

In Summary:   Ø  Expect that the hospital environment and illness will impact on your blood glucose levels   Ø  Discuss with staff what your usual blood glucose range is:  If you are noticing a significant increase or decrease, then a medication dose review is indicated.     Ø  Alert staff to any changes in your dietary intake or appetite.  Medications may need to be altered to prevent hypoglycaemia (low blood glucose)   Ø  Request extra food (or food at unusual times) if needed.  Food is always available.     Ø  Alert staff to any symptoms of hypoglycaemia (low blood glucose) IMMEDIATELY.   Ø  Ensure you are aware of any changes to your diabetes management PRIOR to discharge.