Once again I am moved to address a huge concern for teens and young adults: admission to the hospital for something unrelated to diabetes. I began to cringe upon reading a post on the diabeteens web site by one of the contributors who clearly knew more about type 1 diabetes management than the hospital personnel. This is scary and happens often because approximately 90 percent of diabetes is type 2 (or considered adult onset). Hospital staff are more familiar with T2DM medical management. Since type 1 diabetes mostly presents in children and young adults, most pediatric hospitals are equipped to handle issues related to diabetes and auxiliary care. When kids are admitted at Children's National Medical Center for a problem unrelated to diabetes, such as an infection or surgery, the diabetes team physician is always consulted to assist with diabetes management. This way insulin is managed appropriately through your particular regime: conventional insulin therapy with NPH/regular/rapid acting analogue, basal/ bolus insulin therapy with Lantus/Levemir/ rapid acting analogue, or insulin pump therapy with rapid acting insulin.
Teens and young adults with all types of regimes are admitted to the hospital for various reasons and must be cared for safely and according to their unique insulin requirements. We recommend that present regimes be continued as much as appropriate during the hospitalization. If someone must not eat after midnight prior to surgery, continue the usual long-acting insulin to prevent high blood sugars overnight. This is essential or surgery might be delayed due to hyperglycemia. For example, in the morning, if you currently use NPH/short/rapid acting insulin, consider decreasing the NPH (intermediate acting insulin) by 1/2 or 2/3 and withhold the short/rapid acting insulin prior to surgery since you would not be eating (NPO). If you take Lantus at night, you won't require extra rapid acting insulin in the morning unless your blood sugars are high (even if not eating). If you use Levemir (twice a day basal insulin), take a typical morning Levemir dose and no extra rapid acting insulin in the morning unless you are high.
If you are on an insulin pump, keep it on and let the basal rates do what they are supposed to do: control your blood sugars when you are not eating. Keep in mind that many hospital staff members have little understanding about insulin pump therapy. It is necessary to educate your nurses and care team about the pump as soon as you are admitted or before the hospitalization. I strongly suggest that you write down insulin doses, basal rates, insulin/carb ratios, correction factors, etc. before elective hospitalization or carry it listed in a card in your wallet in case of an emergency. Do not worry if the information is not readily available in written form. Your diabetes team knows how to extract the information from insulin pumps. When I am on call at the hospital I often consult on kids and teens who come into the hospital for emergency treatment. I get the information from the pump and often ask my insulin pump nurse to run interference with the hospital staff and family members. Education is the key and you MUST feel safe in the hospital.