People with diabetes admitted to hospital must be cared for by appropriately trained staff, provided with access to a specialist diabetes team, and given the choice of self-monitoring and managing their own insulin. Many a times, people with diabetes have faced issues in inpatient care, some of which include: the development of DKA and hypoglycaemia in hospital; issues with staffing; difficulty accessing multidisciplinary foot-care teams (MDTs) and a lack of support for patient involvement and self management.
In the year 2016, The American Diabetes Association, came out with Clinical Guidelines in the Standards of Medical Care in Diabetes-2016. A major section of that deals with management of patient with diabetes in a hospital. The major recommendation of the guidelines are as follows:-
- Consider performing an A1C on all patients with diabetes or hyperglycaemia admitted to the hospital if not performed in the prior 3 months.
- Insulin therapy should be initiated for treatment of persistent hyperglycaemia, starting at a threshold $180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) is recommended for the majority of critically ill patients and non critically ill patients.
- More stringent goals, such as 110–140 mg/dL (6.1–7.8 mmol/L) may be appropriate for selected critically ill patients, as long as this can be achieved without significant hypoglycaemia.
- Intravenous insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin infusion rate based on glycemic fluctuations and insulin dose.
- A basal plus bolus correction insulin regimen is the preferred treatment for non critically ill patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for patients with good nutritional intake.
- The sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged.
- A hypoglycaemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycaemia should be established for each patient. Episodes of hypoglycaemia in the hospital should be documented in the medical record and tracked.
- The treatment regimen should be reviewed and changed if necessary to prevent further hypoglycaemia when a blood glucose value is ,70 mg/dL (3.9 mmol/L).
- There should be a structured discharge plan tailored to the individual patient.
There is a whole chapter dedicated to management of Diabetic patients in a hospital setting. To read further click on the following link: