Chris Memering, RN, CDE, has been practicing diabetes education for the last eight years as an inpatient educator at CarolinaEast Medical Center in New Bern, North Carolina. Ms. Memering volunteers with the American Association of Diabetes Educators (AADE), where she currently serves as the Member Affiliate’s Liaison to the Board of Directors. She is still somewhat new to the #DOC. You can find her on Twitter at @zsquaredmama.
My experience with the #DOC (diabetes online community) is that this group of people is in tune with their diabetes and manages it well. Sure, you have an occasional high or low, but you know how to handle it and how to correct course.
But what happens when you get sick—I mean really sick? So sick that you are taken completely out of the world you control and into the hospital? No matter your type, being in the hospital can feel like being in a hurricane—stormy with occasional calms.
My colleague Rachel Head shared some great tips on how to advocate for yourself and your diabetes while in the hospital. Now, I’m sharing three common questions I have been asked in my eight years as an inpatient diabetes educator from people with diabetes.
1. Why am I not seeing my doctor?
Hospitalized medicine has changed. Many primary care doctors no longer take privileges at their local hospital, nor do all the specialists, such as your endocrinologist. Most hospitals now have a team of attending doctors known as hospitalists. These MDs specialize in that which brings people to the hospital. Does this mean they work in a vacuum and don’t call on specialists when they need to? Absolutely not!
And why doesn’t your endocrinologist come into the hospital? Well, how easy is it to get an appointment at the one endocrine office in town if you are a new patient? Forever, right? Many specialists don’t take hospital privileges, not because they don’t want to see you if you are there, but because the workload burden would be too high. We all know we need more endocrinologists. If you feel like there is a problem, pass on your endo’s phone number and the hospitalist will call.
2. Why are you changing my medications?
Over the course of your diabetes, your medications change. What worked four years ago may not work now, or at least not in the same doses. This is especially true for people with type 2 diabetes. Think of the hospital as life in fast forward. Renal function, antibiotics, infections, procedures, eating status, and stress all play a part in how your blood sugar may change. These things, of course, effect blood sugar while out of the hospital too, but if you are in the hospital and really sick, the effects tend to be magnified.
Oral medications in the hospital are just bad news. Here are three reasons why this is:
- Your kidneys are asked to protect you from so much while in the hospital, from radioactive dyes to antibiotics; they don’t need to try and get rid of Metformin too.
- Sulfonylureas stimulate the body to make more insulin, and you need to eat with these medications. But I think our favorite thing to do in the hospital is tell you not to eat, so what happens to your risk for hypoglycemia with these?
- SGLT-2 inhibitors rely on your kidneys to filter and remove excess glucose from your body. They also act as a diuretic. Diuretics can decrease your blood pressure. But what if you’re in the hospital for a myocardial infarction, and all your blood pressure and heart medications need to change?
Rule of thumb if you are hospitalized with diabetes: you are likely to receive insulin in some form or another. And if the hospital is really savvy, your oral meds will be replaced with basal, prandial, and corrective insulin.
But, if you feel like your insulin doses aren’t adequate or that they will cause hypoglycemia, please SPEAK UP! Many hospitals still use “sliding scales” to treat hyperglycemia, but that does not mean your correction plan can’t be ordered. We just need to know how you correct, not just “it depends on my sugar.”
3. You’ve changed my meds. What do I do with the medications I have at home?
First, check your labels against the discharge papers. Sometimes we use generic names and you are used to the brand name or vice versa. If you are sent home on insulin, it may be temporary. You may not want to automatically get rid of the oral medications you have at home. Check with your primary care doctor at your follow-up visit.
If you are treated with insulin at home and were able to take the insulin home with you, first, figure out which pen/vial is going to expire first. Have you been in the hospital for a couple of days or a couple of weeks? Did you open a new pen a few days before you came into the hospital or a few weeks before? Throwing out insulin is akin to throwing out gold, I know, but do you want to use insulin that could potentially send you back into the hospital?
Most importantly: if there is something that doesn’t make sense on the discharge papers, ask about it. Not all EMRs (electronic medical records) have the most lay-person-friendly discharge papers.
What other questions do you have?