Blood Sugars in the Hospital

Let’s pretend you need surgery in the near future - and after that surgery, you’ll remain in the hospital for at least 2-3 days. If you’re like many, you’ve gone over the details of the surgery and hospital stay, but may have neglected to ask who will be in charge of your diabetes care while you’re an inpatient.

I can tell you first-hand this can make a tremendous difference in your care. I’m privileged to work alongside other Certified Diabetes Care and Education Specialist (CDCES) in the hospital setting. This gives me an “insider’s view” on the difference in care when someone knowledgeable in diabetes medication and management is involved. Often blood sugars are more stable, treatment options are more flexible, and homegoing transitions are smoother.

Managing blood sugar levels in the hospital

This was validated by a number of presentations at the annual Association of Diabetes Care and Education Specialists (ADCES) conference this year. Quite frankly, despite national guidelines to guide diabetes care in the hospital, there are still a lot of variations in how diabetes is managed even within different sections of each hospital, let alone hospital to hospital.

One presentation, in particular, by Dr. Sally Gerard, zoomed out to look at the diabetes-care differences in four hospitals of similar size and location. Hospitals with diabetes care teams, who were frequently updated on the most current national guidelines, had patients with lower and more stable blood sugars levels. Her findings are supported by other research presented, showing that specialty teams for diabetes increased your chance for better blood sugars and leaving the hospital sooner.¹

A secondary presentation, by Dr Umpierrez and colleagues, showed higher blood sugars inpatient are connected to higher risks for hospital complications like heart attacks, infections, kidney or respiratory failure, and death.  Yikes.²

This piece isn’t meant to scare or intimidate you. It’s just that we focus a lot of energy on talking about diabetes outside the hospital. Rarely do we talk about what happens inside those four walls.

Prevention of further complications

Bluntly put, diabetes care in the hospital matters. Which makes sense, knowing diabetes is a complicated condition and you’re likely in the hospital for a serious surgery or illness. Combine that with nursing staff shortages, rotating shifts, timing and type of food and medication, lack of knowledge diabetes specialists, and a host of other factors and it quickly gets complex.

What can I do to prepare for my hospital stay?

1. Ask questions during pre-surgical appointments. How will my blood sugar be managed during surgery? What about after surgery? Who will be in charge of that part of my care?
2. You can call your local hospitals and see if they have a diabetes team or specialist in the hospital. A specialist could be an endocrinologist, certified diabetes care and education specialist, or a physician or nurse practitioner whose sole job is to help manage blood sugar levels inpatient.
3. During admission, you can ask staff if they have a diabetes specialist in the hospital who manages blood sugars. I can tell you from experience we aren’t added to every case, and there are times when we are added late in the game (after someone has had days of high blood sugars).

I am very aware that a lot of hospitals still struggle to add diabetes specialists to their inpatient programs. If you don’t have a local hospital with a program, I’m still a big believer in asking questions. In the hospital, the more you engage in your diabetes care, the more likely it will be watched and tracked. Hopefully, netting you an improvement in your blood sugar levels, and your overall health and well-being.