What to Expect When Admitted to the Hospital - Part 2
In Part 1 of this series, I addressed why changes in blood sugar monitoring happen when you’re admitted to the hospital. Now, I’ll tackle why your usual diabetes medications may be stopped in the hospital and when and why the decision is made to start insulin dosing.
Hospital stays and medication changes with type 2 diabetes
Let’s start with medications. It’s pretty typical to have your medications changed up in the hospital. There are many reasons for this:
1. Medication availability
Your diabetes medications may not be available in the hospital. Many of the medications that can be expensive for you are also expensive for the hospital. So newer classes of diabetes medications may not be available to replace your home routine. You can always ask to use your home supply when you’re admitted.
2. Medications causing risk
Your medications may add unnecessary risk. To work well and decrease side effects, metformin and the SLGT-2 class (Invokana, Jardiance, Farxiga, etc) need your kidneys to be healthy and hydrated. If you’re severely ill or having major surgery, you’re more likely to be dehydrated. Certain medical tests that require contrast dye to be used, can stress your kidneys, making them work harder. Thus, most medical teams will stop these medications for a short time while so many changes are happening in your care.
3. Poor health status
Your body may not be working well enough to use your diabetes medications. Most (not all) diabetes medications are processed through your kidneys. If your illness is critical enough that your kidneys are not working well, it may no longer be safe to use your home diabetes medications. Or, at the very least, the doses may need to be lowered.
4. Improvement for blood sugar control
Your diabetes management plan wasn’t working before admission. If you were struggling with your blood sugar levels before your hospitalization, it’s a pretty good bet that the stress of illness or surgery will only increase your need for diabetes medications.
Insulin in the hospital
A quick note on insulin (if you were already on it before admission), chances are your doses will be lowered, with a gradual increase back up to your home doses (or more if needed). This a safety precaution.
If you weren’t on insulin before admission, then your illness, treatment plan, or challenges to using your home medications, may leave your medical team few options other than insulin to maintain healthy blood sugars. If you’re having blood sugars consistently over 180 mg/dl, it’s likely that you will be given insulin either once daily and/or with meals and bedtime.
Insulin can sound intimidating if you’ve never needed it outside the hospital, but it’s an incredibly valuable tool. Keeping your blood sugars in safe ranges can prevent a number of hospital complications like infections, surgical complications, longer hospital stays, even death.1 Insulin gives your medical team flexibility to address your ever-changing needs in the hospital.
Expect changes and ask questions
To sum up this series, I’ll simply say that hospital care is challenging, but not impossible. We have guidelines and recommendations for insulin initiation and safe blood sugar levels. There are a number of moving parts, so expect changes to happen. But, be sure to ask questions so you understand why changes are being made to your diabetes management plan.
Do you live with any sleep disorders (eg. insomnia, sleep apnea, RLS) in addition to your diabetes?