What to Expect During a Hospital Stay with Type 1 Diabetes
Editor’s Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and a person with type 1 diabetes, working on the same unit she was diagnosed at 26 years ago.
Preparing for a hospital stay can be overwhelming for anyone. Preparing for a hospital stay and having type 1 brings up so many more questions such as blood sugar control and insulin levels. Knowing what to expect, what things to bring, can help you feel more prepared and more confident going into your visit.
How to prepare for your stay
1. Talk to your endocrinologist. They are the best resource when it comes to managing your diabetes while you are in the hospital. Let them know what you are going in for and what time the procedure. They will typically give you a plan to follow on the night before and day of your procedure to help adjust to the fasting that is required before surgery.
2. Talk to the physician performing the procedure. Share the plan you and your endocrinologist came up with. Ask them what to expect in regards to the type of care their facility provides when the patient has a type 1 diabetes. ( A little more on this is described later) The more questions you ask, the better you will feel.
3. If you are the one scheduling the procedure, make sure the scheduler you are speaking with is aware the patient has type 1 diabetes. They most likely will schedule you first thing in the morning. This is to help avoid any issues related to the fasting that takes place before most procedures. It’s typically an eight-hour fast. So if a person with diabetes is fasting during a time when they normally sleep it tends to affect their blood sugar less.
Inpatient vs. Outpatient visit
There are two types of hospital visits, inpatient and outpatient. Outpatient are visits that last less than 24 hours. Inpatient visits are those that are expected to last for 24 hours or more. These types of visits are approached differently in terms of the type and intensity of diabetes care the facility provides.
For an outpatient visit, the facility is just focusing on the specific procedure (i.e. they perform the procedure, you stay for an hour or two after, and then you go home). For this type of visit, the care team will monitor your blood sugar, but will only intervene or make adjustments with your rates or ratios if absolutely necessary.
For inpatient visits, there are a few different scenarios that can occur depending on where you will be staying. If it is considered a non-pediatric facility, you could be given the option of doing all of your diabetes care on your own. In this case, you will sign a waiver that states that this is the plan and you are okay with it. If it is a pediatric facility, more than likely you will be relinquishing some control over your diabetes while you are in the hospital.
What to bring
1. Your own lancet device and lancets—The ones in hospital are AWFUL. If you have little ones, they will appreciate this. Hospitals have their own meters they have to use for readings but you may use the lancet of your choice.
2. Your monitor—Some facilities have the ability to download your meter and see your results. This can help them see how your blood sugar runs at certain times of day. If you don’t bring it, no biggie.
3. Your home insulin dosages and carb. ratios—The plan at the hospital will most likely be to use your home regimen while you are hospitalized.
4. Pump and CGM supplies—(more on how hospitals handle pumps and injections a little later) If you are getting a magnetic resonance imaging (MRI), most pump and continuous glucose monitor (CGM) manufacturers recommend that you remove it.
5.Carb free snacks—(for inpatient stays) This is so you have something to eat in between insulin doses instead of string cheese and sugar-free jello.
6. Chargers—don’t forget the chargers for cell phone or any other device you use.
What to expect during your stay
The number one goal for all people with diabetes is tight blood sugar control. This is even more important in the hospital setting as tight blood sugar control helps facilitate recovery. As discussed above, there are a few different options as far as who does what in terms of diabetes care. For this I will be focusing on the plan where the facility provides the majority of the diabetes care.
During anesthesia, it will be your anesthesiologist’s responsibility to follow your blood sugar. Even if it is a short procedure, you can request that your blood sugar be taken while you are under. It is common to let people with diabetes run higher during procedures as this is easy to correct post procedure. If you run low during a procedure, there are medications they have at bedside that they will give you through your IV to raise your blood sugar quickly. No person with diabetes ever goes into a procedure without an IV. In some cases, you could be placed on an IV fluid containing dextrose (a form of sugar) until you are able to eat. If this is the case, your blood sugar will be checked periodically and the rate the IV dextrose is going in can be adjusted based on that.
After your procedure is over and you’re able to eat, the bolus insulin will start back up. The first thing you need to know is that insulin is considered a HIGH ALERT medication in a hospital setting. This means that any time insulin is given, it requires two nurses to verify the dose and sign off on the administration of the med. (This is not because nurses do not trust you or family members to give the right dose of the right insulin, it’s just policy). If you are on injections, you may opt to give the injections yourself once the dose is verified.
Pump wearers, there are a few different scenarios that could take place for your stay in the hospital. Again, the scenario being focused on is the one where the hospital is taking responsibility for the diabetes care. If you have a pump, you will more than likely be asked to remove it and be placed on a hospital issued pump. You also may be asked to sign a statement saying that you agree to not touch the pump while you are there. (This is because the hospital staff is trained on their hospital pumps and this lets them be able to verify insulin delivery is accurate.) Even if you use the same make and model of pump the hospital uses, you will still be more than likely be asked to switch to a hospital pump.
If you want to be more involved in your care, speak up. If you want to do your own site changes, or your own injections, or own finger sticks, just say so. Also, it’s a good idea to verify insulin doses with the nurse before they are given. They can explain the carb. count and ratio used to cover carbs and also the correction factor being used.
The most important thing you should do during your stay is make sure there is an endocrinologist involved in your care. For outpatients, having that plan you discussed with your endocrinologist is an important part in making sure things so smoothly. For inpatients, during your admission to the facility, make sure you ask for an endocrinology consult. This means that an endocrinologist will be part of your care team while you are in the hospital. You can also request that the endocrinology team be the one to make changes or adjustments to the patient’s diabetes regimen. This often leads to better blood sugar control during hospitalizations.