When Hospitalized, Insulin is Not Your Enemy
Hyperglycemia the real foe for patients managing diabetes.
Q. I have type 2 diabetes and need surgery on my shoulder. I am worried about stories that I heard from other diabetics who had surgery having to start taking insulin. I'm a little nervous about needles and getting cut on. Appreciate any info.
A. Facing surgery is a scary prospect in and of itself. For people who have never taken insulin, the thought of needles only adds to the fear. Plus, if you have heard some of the endless stories and myths circulating about insulin, it only makes matters worse. You want to go into surgery feeling as confident and relaxed as possible, with minimal anxieties. I hope that after you read this column about the enormous negative impact high glucose levels (hyperglycemia) have on people who are hospitalized, and the incredible benefits of insulin, you'll feel a little less nervous.
Imagine being hospitalized with a fever of 103 degrees and the hospital staff doesn't give you any (or not enough) medication to reduce it. Too often, that is the case for people with hyperglycemia—it goes untreated, under-treated, or worse—undetected. Until recently, it was felt that mild to moderate hyperglycemia didn't really matter. Now we know better. The research evidence points very strongly to the importance of maintaining tight control of glucose levels when hospitalized. Meticulously controlling glucose improves recovery from illness, reduces mortality (death rate), post-surgical infections, and the length of time spent in the hospital—definitely good things!
How high is high? According to recommendations made by the American Diabetes Association (ADA) Diabetes in Hospitals Writing Committee, glucose levels should be maintained as follows:
- In the Intensive Care Unit (ICU), less than 110 mg/dl (6.11 mmol/l) at all times
- In non-critical care units (like the medical-surgical units), less than 110 before meals, and a maximum of 180 mg/dl (10.00 mmol/l)
- The lower limit for all areas, 80 mg/dl (4.44 mmol/l)
I first learned about these new national standards at the 2004 American Association of Diabetes Educator conference. I was, and still am, outraged. Did you know that at least 25% of all hospitalized adults have hyperglycemia and/or undiagnosed diabetes?
Our nation's hospitals, including where I work at Community Hospital of the Monterey Peninsula, are struggling with hyperglycemia. The solution will require time and a multidisciplinary (several different types of healthcare providers) commitment to developing a successful plan. I am fortunate enough to work in a facility that allowed me to voice my concerns and study the problem of hyperglycemia in our own back yard (the team investigating the problem of hyperglycemia is called the "Glucose Patrol" and is comprised of several physicians, nurses, educators, dietitians, and pharmacists). Our in-house studies confirm the national trends: hyperglycemia is common. We are very good at starting some sort of therapy and are much less successful at controlling hyperglycemia adequately. The Glucose Patrol is dedicated to changing that trend by starting standards to best meet the needs of our patients with diabetes. It is very exciting to see the progress and enthusiasm of staff who want to tackle this problem and make a difference. But this is just one small hospital on the West Coast.Page: 1 | 2
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James Joyce said that “mistakes are the portals of discovery.” I wonder if insulin levels have been our mistake. Could it be that this hellish week of blood sugars were somehow meant to be? Drastic times call for drastic measures, right? Maybe we were too afraid in the past to take the plunge into drastic measures. Maybe this is oddly what we needed. We had to be truly frightened in order to make bigger, bolder changes. ...