Diabetes and Admission to Hospital

Background

Admission to hospital can be a challenging time and illness can have a range of effects on the management of diabetes.

The journey through hospital admission, inpatient care and discharge requires assessment and management of risk for every patient admitted to hospital. People with diabetes do not necessarily experience illness more often than those without, they are more likely admitted with their diabetes, not because of it, and care is therefore provided across all wards and departments.

National and local guidelines inform and guide the standard of care expected. The recommended target for blood glucose (BG) range in hospital for people with diabetes is 6.0-10.0mmol/L with 4-12 mmol/L being acceptable. Individual targets can be agreed, for example if there are concerns about the risk of hypoglycaemia (low blood levels).

Safe medicine management can reduce the incidence of inpatient harm associated with high blood glucose levels (hyperglycaemia), namely Diabetic Ketoacidosis, Hyperosmolar Hyperglycaemic State, and low blood glucose levels (hypoglycaemia). Some medications routinely prescribed in diabetes should be temporarily stopped during illness to reduce the risk of complications associated with their action and dehydration.

People with diabetes are at much greater risk of developing problems with their feet due to loss of feeling (neuropathy) and circulation problems (ischaemia). Bed rest can increase the risk of pressure ulcers. Pressure relieving devices to reduce the pressure on the feet should be available in hospital wards.

THINK about what matters to you and your diabetes

• Illness, changes in your usual routine, changes in food intake and activity associated with hospital admission can affect your diabetes management.

• During illness and hospital admission your medication may need to be altered to aid glucose control, and to reduce harm if taken during a severe illness that can lead to dehydration.

• Good management of blood glucose levels during illness; and before, during and after surgery; will aid recovery, with less risk of complications

CHECK

• If you have any concerns about your diabetes before admission to hospital you can speak to your GP, Practice Nurse or contact your diabetes team.

• Before elective surgery it is important that your diabetes is well managed as this can aid your recovery and reduce the risk of cancellation of surgery. Surgical preassessment clinics are available for advice including diabetes care planning.

• Discuss and agree specific care requirements with your health care professionals.
  

ACT

• Bring an up-to-date copy of your repeat prescription with you when you attend hospital. This will provide information to help with your medication and prescription needs in hospital.

• Check and protect your feet, ask for help if you can’t check yourself.

• Ask for referral to the diabetes team if required for advice and support for your diabetes management.

• Ensure that you have contact details and sources for advice and support for your diabetes management following discharge from hospital.

• Diabetes check-ups can be arranged in your GP surgery, in 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

How to advise on sick day rules. Diabetes & Primary Care Vol 22 No 3 2020 - https://diabetesonthenet.com/wp-content/uploads/pdf/dotn024ae8fb1b78500b7bc752b98e9b6d92.pdf 

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

How to advise on sick day rules. Diabetes & Primary Care Vol 22 No 3 2020 - https://diabetesonthenet.com/wp-content/uploads/pdf/dotn024ae8fb1b78500b7bc752b98e9b6d92.pdf 

Scottish Government diabetes Improvement Plan 2021-2026 - https://www.gov.scot/publications/diabetes-improvement-plan-diabetes-care-scotland-commitments-2021-2026/pages/4/

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