By: Doris Dickson for Diabetes1
A frequent conversation among severely insulin-dependent diabetics concerns blood sugar guidelines while being hospitalized. Patients with diabetes in emergency waiting rooms or surgical/out-patient procedures may not get appropriate blood sugar management from the medical staff. In addition, inadequate control of blood sugar while in the hospital can result in patients feeling poorly, which may delay the healing process.
Patients say that they are sometimes denied insulin unless their blood sugar is 150-200 mg/dl (double a normal, non-diabetic blood sugar level). Intravenous medications often include glucose additives (saline or antibiotics). Due to these concerns, patients with diabetes often avoid surgical procedures unless given no other choice.
Margo Hudson, M.D. of Boston’s Brigham & Women’s Hospital says that “the guidelines are now 150 mg/dl, down from 200”. She agrees that medical professionals now realize hyperglycemia hinders healing. Although 150 mg/dl is still substantially higher than normal blood sugar levels, it is, as Dr. Hudson puts it, “one step at a time”. Yet these guidelines may not always be followed in local regional hospitals.
Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S., FACCWS, author of Diabetes Solution, believes all diabetics are entitled to non-diabetic blood sugar levels. He writes, “Don’t permit hospitalization or lengthy outpatient procedures to impair your blood sugar control.” He blames the lack of blood sugar control on hospital medical staff who:
- Lack blood sugar control skills
- Are unaware of the importance of normal blood sugar in the face of surgery or illness
- Have an almost “pathological” fear of hypoglycemia
As Dr. Bernstein notes, many studies of hospitalized patients demonstrate the negative effects of elevated blood sugar levels. They include:
Surgical healing delay
Increased risk of post-surgical morbidity and mortality
Delayed recovery from infection and increased risk of infection
Increased death rate in patients hospitalized for heart attack or stroke
Increased risk of a new heart attack or stroke
In order for patients to receive the same care in the hospital as they provide for themselves at home, Dr. Bernstein includes a sample letter in his book. He suggests addressing the letter to the admitting physician and the hospital administrator. This letter may also be beneficial if the patient is having outpatient surgery in a physician’s office or hospital outpatient clinic.
Basal (long acting) insulin type and doses
While in the hospital, let the medical staff know:
Instructions for low blood sugar correction
Request for a “normal” diet so you can select your own meals
Designated target blood sugar levels
Blood glucose meters, test strips or blood sugar control medications should never be confiscated
For additional resources on the topic, the Joslin Clinic has written a Guideline for Inpatient Management of Surgical and ICU Patients (Pre, Peri and Postoperative) Care. The guideline provides a choice of two algorithms. One algorithm uses a blood sugar target of 80-110, the other a target of 101-150. Both algorithms instruct providers to avoid the use of dextrose in IV fluids, unless an insulin infusion is required. However, the Joslin Clinic encourages avoiding insulin infusions if blood sugar levels can be adequately managed through insulin injections.
So, if you have diabetes and are heading to the hospital, take heart. With these simple guidelines, you can be ensured that your health is being properly cared for by the medical personnel at your local hospital.
Source: Diabetes Solution, R. Bernstein