Treatment with insulin in hospital

Background

Insulin is considered a high-risk medication therefore insulin prescribing and management are key safety priorities in hospital.

Around 30% of people admitted to hospital are routinely treated with insulin. Need for insulin treatment increases during admission to manage glucose levels during acute illness, surgery, or due to other treatments such as steroid therapy or artificial feeding.

Intravenous (IV) insulin is used in hospital to manage glucose control in the management of conditions such as: acute diabetes emergencies, acute illness, surgery requiring general anaesthetic and in patients with diabetes who are unable to eat and drink. Emergency protocols and guidelines are available locally and nationally to guide care.

THINK about what matters to you and your diabetes

• Think about how you would like to administer your insulin while in hospital. Do you wish to do your own injections? If you use an insulin pump think, do you currently feel well enough to self-manage your pump?

• Nurses have a responsibility to make sure you are given all your prescribed medication in hospital, so it is important to have a mutually agreed plan to support self-administration of your insulin injections.

• If you normally adjust your insulin according to the carbohydrate content of your food, you can discuss and agree your insulin prescription requirements with your health care team, aiming to reflect the variation in your insulin dosing required for carbohydrate intake. The diabetes team can assist with this.

• If you are very unwell, unable to eat and drink and/or you require an anaesthetic and surgery, you may require intravenous (IV) insulin infusion into a vein.

• IV insulin allows for more accurate insulin dose administration and as a result helps balance blood glucose levels within an acceptable, safe range. You should expect your blood glucose to be checked every hour.

• Intravenous insulin works differently to insulin given by subcutaneous injection, IV insulin works immediately when infused in to a vein. When the insulin infusion pump is stopped the action of the insulin will stop within minutes. The time action profile of subcutaneous insulin is longer, depending on the type of insulin.
  

• Special note: If you have type 1 diabetes and/or you are treated with multiple daily injections, you should continue to take your background long-acting basal insulin e.g. Glargine (Lantus®, Toujeo®, Abasaglar®), Detemir (Levemir®), Insulin Degludec (Tresiba®) as usual every day, including during treatment with intravenous insulin infusion. This will ensure that there is always some ‘background’ insulin circulating in your body and will reduce the risk of Diabetic Ketoacidosis. This also aids the safe transition to your routine insulin injections.

• Transfer from IV insulin to subcutaneous insulin injections is recommended when you are clinically better and managing to eat and drink. Your usual insulin should be restarted at a suitable mealtime before the IV insulin infusion is stopped.

• If you use an insulin pump, individual assessment and discussion with your diabetes team will guide your care during illness.

CHECK

• Check that you feel well enough to manage your insulin in hospital safely and what’s in place if you need some help.

• There may be times when you will require extra support to self-manage your insulin, for example if you feel too unwell to safely self manage, and /or you have memory or dexterity problems. Nurses can administer your insulin for you if you are unable to self-manage injections.

• Check out safe storage in the ward for your insulin, pen needles (and insulin pump and supplies if appropriate). ‘In use’ insulin can normally be stored at room temperature for 28 days and should not be stored in the ward fridge.

• Check that you know how and where to dispose of your sharps (pen needles and lancets). A sharps disposal unit must be provided for you by the ward staff to allow you to dispose of your needles or ‘sharps’ safely.

• If you are new to insulin, you will require information, education and follow up and supplies to manage your treatment.

ACT

• Act to work in partnership with your healthcare team to agree your insulin prescription and how best to manage your insulin injections or insulin pump in hospital.
  

• If your diabetes is usually treated with insulin, bring supplies with you to hospital.

• If you are new to insulin, you will require a starter pack along with equipment to help you safely manage your treatment at discharge from hospital. Follow up for advice and education should be arranged for you.

• The diabetes team can provide advice and education about all aspects of insulin treatment, ask for referral to the diabetes team if required.

• Structured education programmes about all aspects of managing insulin treatment are available, find out more from your diabetes team.

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

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