The 'law' of hospital blood sugar

One thing almost every diabetic agrees with:  "When I'm in the hospital, my sugar goes all out of whack."  And it certainly seems to be true, but does it have to be?  The two major reasons for this are 1: sickness leads to insulin resistance, and 2: medications are routinely held in the hospital.  So the question then is, are 1 + 2 good enough reasons for diabetics to run high in the hospital?

Well, to understand this, we need to go back in time (say 20 years ago).  In the good old days, diabetics would run high in the hospital, and everyone would say- "well of course, diabetics who are sick are going to have higher sugars."  So the traditional view was to tolerate hyperglycemia as a cause-effect natural event.

However, over the past decade, research is coming out which shows that diabetics with better control in the hospital get less infections and go home quicker (not to mention living to tell about it), than out of control diabetics.  So it seems egg/chicken- high blood sugars can cause or exacerbate sickness as well!

Since high blood sugar is deleterious to patients, we need to see if 1+2 are good reasons or not.  Well, 1 certainly is not- in fact, what do docs tell you when you're home and sick?  Don't skip your insulin!  Again, this is because infection and fever cause insulin resistance, so even if you're not eating, you can go too high.  This is a common cause of DKA and hospitalization- the dangerously high sugar of sickness.  So when you're in the hospital, and your sugar is higher than normal, you may just need more insulin, until the infection resolves.  In other words, if the hospital is holding your insulin because you're not eating, or your regular regiman isn't effective, you may need more insulin coverage while in the hospital, rather than the historical reaction "oh well, you're sick".

And is 2 a good reason for running high?  Well, often oral meds are held with good reason.  But then, as above, you'll probably need some basal (slow acting) insulin to cover you while you're in the hospital.  And it's the same with insulin regimens- even if you're revisiting you're meals in reverse over the john, you'll still need basal insulin, while of course holding any short acting.  So holding meds is not a good reason for running high, but rather it's usually the cause of running too high.

So if you're ever in the hospital, and your blood sugar is higher than a perfect bowling game, don't just lie back and say, "oh well, I'm in the hospital and my sugar is out of whack."  Feel free in between boring TV game shows to ask the doc if your insulin regimen might be changed.