When Hospitalized, Insulin is Not Your Enemy (Continued)
Q. What can you do to combat hyperglycemia if you find yourself in your neighborhood hospital?
A. Inform the staff. Make sure they know you have diabetes.
Ask to have your glucose level taken regularly (typically done before meals and at bedtime, and more often based on values). I am amazed at how often glucose levels are not checked.
Bring your glucose monitor to the hospital. Some people find comfort in knowing they can check their glucose on a moment's notice. Plus, if you feel up to it and the hospital allows, you could check your glucose as ordered by the doctor instead of using the hospital's system (which can have painful lancets).
Realize that insulin is your friend. It has only been around since the 1920s. The Portland Protocol, which is a new national standard for insulin use in the hospital, is placing all people going into surgery, whether or not they have diabetes, on a low dose insulin drip because of its benefits.
Know that it is normal to be afraid of needles, at first. If you liked needles, we'd worry! Trade secret: the new insulin needles come in short, skinny sizes, and oftentimes hurt less than poking your finger with a lancet. For some, insulin might be needed for a short time during a hospital stay. For others, insulin is needed long term to keep glucose levels in check. Insulin is one of the best things we have to help control diabetes. It is not the problem—high glucose levels are the problem.
Request your surgery be done in the morning. If your surgery is later, your glucose levels might be harder to control. Even one reading above 200 can have an impact. Ask the surgical team (nurse, surgeon, physician, and/or anesthesiologist) about your medications for the day of surgery. Some medications should not be taken; others are split in half.
Bring an advocate. Who knows a lot about your diabetes and can stand up for you if need be? Studies show it is not uncommon for doctors and nurses to have a basic lack of knowledge and understanding about diabetes. You may have more knowledge about the best way to control your diabetes, but may be too ill to articulate that. So have a family member or friend step up to the plate.
Ask to see a diabetes educator. Not all hospitals have registered nurses, registered dietitians, and pharmacists who specialize in diabetes, but many do. If you need an advocate, a diabetes educator will do just that. You can also ask for an endocrinologist evaluation (a doctor who specializes in diabetes) if your diabetes is not in control.
Control pain. The old adage, "No pain, no gain" is hogwash. Pain raises glucose levels and interferes with healing. Try not to be tough. If you are in pain, let the nurse know.
The best place to play jeopardy is outside of the hospital. Ready? What can double the amount of time you spend in a hospital, increase your risk for a heart attack or stroke, increase your chance of an infection, or increase your chance of leaving this planet forever? Hyperglycemia!
You can minimize your risks and concerns by controlling hyperglycemia in the hospital setting. And luckily, advocates are there to help.
1-Campbell, Kristen B. and Susan S. Braithwaite. 2004. Hospital Management of Hyperglycemia. Clinical Diabetes 22(2): 81-88.
2-Clement, Stephen, Susan S. Braithwaite, Michelle F. Magee, et al. 2004. Management of Diabetes and Hyperglycemia in Hospitals. Diabetes Care 27(2): 553-91.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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