Inpatient Diabetes Management: Case 7

December 20, 2007

90px-glukometr_ot.jpgCommentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center

Welcome to our final case of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. Over the last few months, we have been presented individual cases followed by some management questions and answers.

Case 7: All our patients go home…
Mr. Smith, Mr. Jones, Mr. Mejia, Mr. Gary, Ms. Samson, and Ms. Longshore are all awaiting discharge. What are the crucial elements for a diabetic’s safe discharge?

A. Specific outline of medication. (i.e. “Take 10 units rapid acting insulin pen prior to your meal. You must make sure your meal is fully prepared and you are ready to eat before you take this type of insulin.”)
B. Inpatient Nutrition consult
C. Inpatient Nurse education regarding fingerstick monitoring, treatment and prevention of hypo- or hyperglycemia.
D. Social work and Case managers’ coordination of home care if necessary.
E. Early phone contact and outpatient re-visit with PMD.
F. ALL of above.

Answer: F

It is essential that the patient has had proper education about his/her diabetes prior to discharge. This must be considered on the day of admission to prevent a last minute scramble on the day (or the hour!) of discharge.  Most patients with newly diagnosed diabetes are quite overwhelmed by the diagnosis.  It is unrealistic to expect most people to learn all of the information that will ultimately be required for mastery of necessary self-management skills.  However, it is critical that they have acquired a minimum of “survival-management” skills education, including how to recognize and treat hypo- and hyperglycemia, how to perform self-monitoring of blood glucose, how to inject insulin and/or take medications (as indicated), a rudimentary grasp of proper nutrition, and how to contact their health-care provider in an emergency or with questions.  In addition, it is important to give an early follow-up (within two weeks) to review the patient’s fingerstick log so that any in-hospital insulin adjustments can be altered if necessary.