Type 1 Diabetes in the Hospital Setting (for non-related diabetes issues)

Dr. Fran Cogen Health Pro
  • 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.

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    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.


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    The hospital staff should be cognizant that you should not get a regular diet; but rather a diet that indicates the carbohydrate count so that you can adhere to your meal plan or count carbs and give your bolus insulin accordingly. Blood sugar monitoring should be conducted by the hospital staff and as necessary by your own glucose meter (the attending physician may need to write orders to that effect).


    Surgeons tend to leave the medical management of their patients to staff or their pediatric medicine associates, so I strongly recommend that you ask for a medical consultation as soon as you enter the hospital in order to advocate for your diabetes management.


    What about outpatient surgery such as wisdom tooth extraction, etc? The same principles apply. My recommendation is to have the surgeon schedule outpatient surgery as the first procedure in the morning. In that way, you can receive your long acting insulin (Lantus, Levemir, or NPH) dose the night before (or in the case of Levemir the night before and morning of surgery.) If on NPH, you should receive about 1/2 -2/3 of your usual dose in the morning and no short or rapid acting insulin in the morning so that you can be NPO after midnight. You should be able to resume eating by lunchtime and your blood sugars should be stable. (Consult your treating diabetes team as they may have slightly different recommendations, but they should be the same in principle.)


    In conclusion, you or your family must advocate for appropriate and safe treatment of your diabetes when hospitalized. Be assertive in obtaining the medical consultation necessary so that you can be confident that your diabetes will be controlled during your hospital stay. Questions? Ask.



Published On: October 14, 2008