Controlling Diabetes: Inside The Hospital

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Controlling Diabetes: Inside The Hospital
 

– Reported April 03, 2012

 

GAINESVILLE, Fla. (Ivanhoe Newswire) –Every year an estimated six million U.S. hospitalizations are accompanied by hyperglycemia, a condition that occurs when your blood sugar is too high. While the condition is often associated with diabetes; as many as 1.5 million hospitalized patients with significant hyperglycemia have no history of diabetes. Controlling blood sugar levels in the hospital can be a life or death matter. Hyperglycemia is a predictor of morbidity and mortality among heart attack, stroke and surgery patients. Studies also show having hypoglycemia (or low blood sugar) in the hospital is tied to higher death risk for diabetics. Kenneth Cusi, M.D, FACP, FACE Professor of Medicine and Chief of Endocrinology, Diabetes & Metabolism at the University of Florida says in order to better control blood glucose inside the hospital, all patients should undergo blood glucose testing once they’re admitted, regardless of their primary medical problem or previous diabetes status.

“We have a lot of people that in the hospital their blood sugars get dangerously high because these are probably undiagnosed patients with diabetes,” Dr. Cusi told Ivanhoe. “There are about 2 to 3 people with pre-diabetes for each diabetic, so it’s estimated that nearly 80 million Americans have pre-diabetes.”

Glycemic control can become unstable for hospitalized patients because of procedures, illness, or changes in diet and physical activity. During the 43rd annual Topics in Internal Medicine Conference in Gainesville Florida on March 29, 2012, Dr. Cusi discussed some of the best practices to manage hyperglycemia in the hospital setting. One solution is medical nutrition therapy (MNT). Dr. Cusi says MNT should be included as a component of the glycemic management program for all hospitalized patients with diabetes and hyperglycemia; it includes providing patients with specific meals that have a consistent amount of carbohydrates. Other ways to manage blood glucose in non-critical care hospital settings include:

· Implementation of glucose management protocols with specific directions for hypoglycemia avoidance

· Implementation of a standardized hospital-wide, nurse-initiated hypoglycemia treatment protocol to prompt immediate therapy of any recognized hypoglycemia

· Implementation of a system for tracking frequency of hypoglycemic events with root cause analysis of events associated with potential for patient harm.

· Institutions should establish a uniform method of collecting and evaluating data and insulin use information as a way of monitoring the safety and efficacy of the glycemic control program

· Institutions should provide accurate devices for glucose measurement at the bedside with ongoing staff competency assessments.

Dr. Cusi says there are a few things that patients can do to help their doctors and nurses take care of them in the outpatient setting: attend a local diabetes education and medical nutrition therapy class, ask your doctor about symptoms of hyperglycemia/hypoglycemia and how to best treat them should it occur, ask your healthcare provider how your insulin or oral agent diabetes medication work and when would you be most vulnerable to hyperglycemia/hypoglycemia, and check your blood sugar frequently if you are on insulin.

(SOURCES: MedStar Research Institute, 43rd Annual Topics in Internal Medicine Conference in Gainesville Florida on March 29, 2012)