Overview

This information explains the care that you can expect for your diabetes while you are in hospital.

At Guy’s and St Thomas’ hospitals, we understand that staying in hospital can be stressful and worrying. Having diabetes can make this even more difficult because you might be anxious about your medicines, food and blood sugar (glucose) levels.

If you take insulin, you might be able to manage your own insulin treatment in hospital (including if you are on an insulin pump). This depends on if you are well enough. You can ask the nurses on your ward if you would like to take your own insulin as you do at home.

This information is intended to reassure you and answer your main questions about diabetes care in hospital. If you have any more questions, please speak to a doctor or nurse caring for you or a member of the diabetes team.

Being diagnosed with diabetes

If you are newly diagnosed with diabetes during your hospital stay and need insulin, you will be referred to our diabetes team. They show you how to do injections, and give you guidance and support to manage your condition, before you go home.

If you are newly diagnosed but your diabetes will be treated with diet or tablets only, we might refer you to your GP. You can then see your GP for help with managing your diabetes soon after you go home.

Structured education programmes are a way to learn more about diabetes and how to manage your condition. These 2 programmes are available in Lambeth, Southwark and Lewisham.

• Type 1 diabetes: DAFNE course (dose adjustment for normal eating)
• Type 2 diabetes: DESMOND course (diabetes education for self-management for ongoing and newly diagnosed)

To find out more about the DAFNE or DESMOND course, please speak to the diabetes team, or your GP or practice nurse.

Seeing the diabetes team

If you are in hospital with problems caused by your diabetes, the diabetes team will see you. Examples of these problems are emergency high blood sugar (hyperglycaemia) or low blood sugar (hypoglycaemia).

There are several other times when the diabetes team would like to see you during your hospital stay. Your ward team knows when to refer you to them.

While you are in hospital, it is usually the ward team that manages your diabetes without the help of the diabetes team. But if you or the ward team have any concerns or questions about your diabetes care, the diabetes team is happy to help.

Special situations

There are some special situations when you need extra diabetes care during your hospital stay.

Foot care

If you have diabetes, you should have your feet checked within 24 hours of being admitted to hospital. We refer you to the foot health team if there are any concerns.

Pregnancy

If you are pregnant, a member of the diabetes team will visit you regularly on the hospital ward. Please continue to check your blood sugar levels and take your medicines, such as metformin or insulin.

Please tell the midwife or nurse your blood sugar levels and the doses (amounts) of insulin that you have taken. They can then update your records. We also check your blood sugar levels using hospital blood glucose meters.

If for any reason you cannot manage your own diabetes, the midwives or nurses will take over until you recover.

Surgery

If you are having surgery, you might need to stop eating and drinking in advance. This fasting, the problem that is being treated and the operation itself can affect your blood sugar levels.

We might do extra blood sugar checks before, during and after an operation or if you have moved between different places in the hospital.

Checking your blood sugar levels

We usually check your blood sugar levels 2 to 4 times each day while you are in hospital. This depends on how you are and what medicines you take.

Sometimes, we need to monitor you more closely. For example, if you need intravenous insulin (given directly into a vein), we check your blood sugar level every hour.

It is fine if you want to test your own blood sugar or check your sugar levels with a continuous glucose monitor or flash monitor. But the ward staff also test your blood sugar levels with hospital blood glucose meters. Sometimes, we can time your blood sugar checks with ours but hope you understand that it is not always possible.

The hospital blood glucose meters connect to our computer system for recording your medical notes and the medicines that we prescribe. We then have your blood sugar readings available when planning your treatment. This helps us to give you the best possible care.

The target range for your blood sugar levels is usually 4 to 11mmol/L (with exceptions). Action needs to be taken if your blood sugar levels are too high or too low.

If you want to know your target range and blood sugar level at the time of testing, please ask your ward team.

Low blood sugar (hypoglycaemia or hypos)

A low blood sugar level is called hypoglycaemia or a hypo. You have a hypo if your blood sugar level drops below 4mmol/L.

Low blood sugar can be a side effect of diabetes medicines, including:

• insulin
• tablets used to treat type 2 diabetes called sulphonylureas (for example, the medicine gliclazide)  

We have information about the signs and symptoms of a hypo. It is important to recognise these signs and tell your nurse immediately if you have any of the symptoms.

A hypo needs to be treated quickly because otherwise this can be dangerous. There should be snacks on your hospital ward. You can ask the nurses or catering staff for a snack to prevent your blood sugar level from dropping too low.

If you have a hypo in hospital, your medicines should be reviewed when it has been treated. We can see if we need to make any changes to your diabetes treatment to prevent more hypos.

Changes to your diabetes treatment

Sometimes, we might need to change your diabetes medicines in hospital. For example, we might:

• increase or reduce your tablets or insulin
• start you on new treatments, such as tablets or insulin (even if you have type 2 diabetes)
• stop your usual medicines

These changes are sometimes temporary. For example, we might stop your metformin before a scan or change your diabetes treatment around the time of an operation. Sometimes, the illness that you are being treated for in hospital affects your diabetes. This could be for a short period until you recover.

You have the right to be:

• involved in any decisions about changes to your diabetes treatment
• told about any changes that take place

More information and support

Diabetes UK

Diabetes UK is a charity for people living with diabetes in the UK. It gives information and support on all aspects of type 1 or type 2 diabetes.

Phone: 0345 123 2399 (Monday to Friday, 9am to 6pm)
Email: [email protected]

Diabetes Research and Wellness Foundation

The Diabetes Research and Wellness Foundation is a national charity. It funds diabetes research and gives educational information and support to people living with diabetes.

Phone: 023 9263 7808
Email: [email protected]