Blood glucose (sugar) monitoring in hospital – avoiding highs and lows

Background

The recommend target for blood glucose (BG) levels in hospital for people with diabetes is 6.0-10.0mmol/L with 4-12 mmol/L being acceptable (Joint British Diabetes Societies for Inpatient Care).

Hospitals have hand held quality-controlled glucose meters for nurses to use at the bedside to check finger prick (capillary) blood glucose levels from a finger prick.

Guidance on Continuous Glucose Monitoring (CGM) systems is that most people using CGM in a medical or surgical ward are safe to remain on CGM if admitted to hospital. However, due to the possible risk of inaccuracy during acute illness, capillary blood glucose should be checked at least twice daily using the hospital meter.

Laboratory blood glucose analysis may be required to confirm accuracy if glucose levels are very high (hyperglycaemia) or very low (hypoglycaemia).

High blood glucose levels (hyperglycaemia).

• There are several reasons for ‘high’ blood glucose levels in hospital which can include, the body’s normal stress response to illness, infection, steroid therapy, different foodstuffs, artificial feeding regimes (tube feeding) or simply a change in your activity.

• High blood glucose levels may slow down the body’s healing process and increase the risk of infection.

• Treatment with steroid can cause high blood glucose levels. Steroids are medicines commonly used for treatments in conditions such as respiratory illness, cancer care, during pregnancy, musculoskeletal and skin conditions, and after organ transplant.

Low blood glucose levels (hypoglycaemia).

• Blood glucose levels (below 4mmol/L) can be problematic in people treated with insulin or diabetes medications such as gliclazide, glipizide, glimepiride, or glibenclamide.

• Problems with low blood glucose levels can be associated with low food intake, change in food intake, and kidney or liver problems. Diabetes treatments can be altered to prevent hypoglycaemia. hypo leaflet 
  

• Glucose levels of 4-6 mmol/L in frail people or elderly patients are viewed as ‘looming’ hypoglycaemia and medications should be adjusted to prevent problems with low glucose levels.
  

THINK about what matters to you and your diabetes 

• Hospital admission, your current health, type of illness, changes in food intake and activity can upset your usual daily routine and diabetes management.

• Optimising blood glucose management before, during and after admission can aid healing and recovery from illness.

• The frequency and number of finger prick tests required will vary depending on your condition and the treatment you are prescribed.

• Diabetes treatment adjustments can be made according to blood glucose results.

CHECK

• How and when your blood glucose (sugar) should be checked in hospital.

• If you normally check your blood glucose at home, you can do supplementary tests in hospital if desired. A sharps box for the safe disposal of lancets should be provided for you.

• Check out the plan for steroid therapy if prescribed. These medications may be administered for various time frames and in variable doses. Blood glucose monitoring is essential to identify problems and your diabetes treatment can be adjusted to prevent high blood glucose levels if necessary, and to avoid problems with low blood glucose levels as the effect of the steroid wears off.

ACT

• Share information with the ward staff about your usual blood glucose monitoring requirements and if you have any concerns about your blood glucose control.

• Learn as much as possible about how your diabetes medications work

• Ask for referral to the diabetes team if required.

• If your medication has changed this may change your monitoring needs - ask for confirmation of your treatment particularly at discharge from hospital.

• It is recommended that you have a diabetes check up every 4 - 6 months. This check-up can be done at your GP surgery, or you may be asked to attend a hospital diabetes clinic.

Resources:-

Diabetes UK and ABCD Your Safe Discharge from Hospital, An Information Leaflet for People with Diabetes - http://www.diabetes-healthnet.ac.uk/Documents/Uploaded/COvIDPatientDischargev2.2.pdf 

Diabetes UK - www.diabetes.org.uk

Diabetes UK When you’re unwell - https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/illness?gad_source=1&gclid=EAIaIQobChMIiOS39NKhhwMVtYBQBh20PQhnEAAYASAAEgIwCvD_BwE

Joint British Diabetes Societies (JBDS) for Inpatient Care - https://abcd.care/jbds-ip

Joint British Diabetes Societies (JBDS) Using technology to support care in hospital - https://abcd.care/sites/default/files/resources/JBDS_20_Using_Technology_to_Support_Diabetes_Care_in_Hospital_1.pdf

TREND leaflets for people living with diabetes - https://trenddiabetes.online/people-with-diabetes/