Guide to hospital stays

If you experience some difficulties managing your diabetes or other health conditions, or you have an accident, you may need to go to the emergency department for assistance or be admitted to the hospital. If this happens, it can help to know what to expect and what questions to ask the health-care team you meet to ensure you are well cared for. It is also important to know what your rights and responsibilities are in these situations.

Guide to being hospitalized

Being admitted to the hospital, whether it’s planned or an emergency, can be stressful. Preparation beforehand will help ensure your diabetes is well managed throughout your stay.

First and most importantly, be knowledgeable about your own health and your own needs. Be prepared to speak up clearly and concisely when you are confused or worried about anything that is happening. Being prepared with up-to-date information about your medical history will help you feel less anxious. It will also help the hospital staff take better care of you, and hopefully have you on the mend and on your way home as soon as possible.

Talk to your health-care team

Even before you are admitted, talk to all of the medical people who are involved in your care (surgeon, family doctor, diabetes health providers), so that you can be confident that everyone has accurate and consistent information about you. Consider asking your health-care team these questions in advance:

• Who will manage my diabetes when I am in the hospital? Will I be able to do this myself? 
• What adjustments to my diabetes medications or insulin dose may be necessary before and after particular medical procedures or surgery?
• What blood glucose (sugar) levels are too high or too low for me?
• Can the hospital staff familiar help me with my insulin pump?

Ask a family member or friend to be your advocate while you are in the hospital

Talk to this person about how you manage your diabetes and also about any concerns you may have about going into the hospital. Provide the person's name and contact information to the hospital staff when you are admitted.

Write down important information to take with you

It’s easy to forget important information, especially if you are worried or ill. Before entering the hospital, spend time making a list for each of the following:

• your medical history, including food or drug allergies and previous medical procedures or surgeries;
• all the medication you are currently taking, including:
  • diabetes medications: brand name, strength, dosage, times to be taken;
  • if you take insulin(s): dosage (number of units), how often, times to be taken;
  • other prescription medications (including creams or lotions);
  • vitamins or herbal remedies;
• the meal plan you follow at home.

Packing

You can make your hospital stay more comfortable by taking the following with you:

• your lists (medical history, medications, meal plan at home);
• your diabetes medications, because hospitals do not always have all types of insulin or other diabetes medications (such as glucagon) readily available;
• blood glucose monitor, blood glucose meter strips, lancing device and lancets;
• fast-acting sugar such as glucose tablets, juice boxes, lifesavers, candy or whatever you usually take when your blood sugar is too low (hypoglycemia);
• cream or lotion for elbows, knees and feet (especially heels) to avoid skin irritations from the hospital bedding;
• sturdy slip-on bedroom slippers or shoes;
• warm, loose-fitting socks, especially if you have circulatory problems;
• personal hygiene items such as toothbrush, toothpaste, shampoo.

Don’t forget: Mark your name on all of your belongings and supplies.

Remember: Make copies of your lists and keep them up to date. Provide one set to the hospital staff when you are admitted, and another set to a family member or friend and keep a copy for yourself.

When you are admitted

Once you are in your room, a nurse will talk to you about your medical history. Give as much detail and be as specific as you can about what has worked for you and what hasn’t in the past. Provide a copy of your lists (medical history, medication, meal plan at home). Make sure you highlight any food or drug allergies. Remember to also provide the name and phone number of your main contact person.

Give the nurse any medication you have brought with you. Keep your blood glucose meter, strips, lancing device, lancets, record book and whatever you have brought to treat low blood sugar near your bedside for easy access.

Explain your meal plan and ask that it be shared with the hospital dietitian, who can use it as a basis for your meals at the hospital. Or if you prefer, you can ask that the dietitian visit you personally to discuss the meal plan.

In an emergency

To prepare yourself for an emergency:

• always carry your essential diabetes supplies with you;
• always wear your medical ID bracelet (for example, MedicAlert ®);
• report to emergency staff that you have diabetes and show your medical ID bracelet;
• carry an up-to-date list of your medications and drug and food allergies in your wallet;
• carry your emergency contact number in your wallet so you or someone else can call a family member or friend;
• if you require immediate assistance but no one is helping, stay calm and keep asking until you receive the help you need.

Important things to know

Blood sugar changes

While in the hospital, your blood sugar levels may be higher than your usual target range. The stress of your illness, being in the hospital, different medical procedures and even infections may cause your blood sugar levels to rise, and your diabetes medications may need to be changed. While this can be frustrating, it is also quite common.

Timing of meals

It is difficult for nurses to know the exact time your meal tray will arrive, so timing your diabetes medications before your meal may be a challenge. If your meal is delayed, try to have a supply of carbohydrate on hand to avoid low blood sugar.

Insulin administration

In cases of surgery, severe blood loss, or serious dehydration, insulin taken through an insulin pump or injection is not absorbed well. Intravenous (IV) insulin may be used as it is delivered more effectively. An insulin solution is slowly dripped into a vein throughout the surgery and for several hours after surgery. The rate of the drip can be easily adjusted by your doctor to maintain your blood sugar level within a target range.

Diabetes specialist

If your own doctor doesn’t admit you, and you have concerns about your diabetes care while in hospital, you can ask to speak with a diabetes specialist (if available). When you meet with the specialist, be specific about your concerns, and be clear about what has and hasn’t worked for you in the past.

When you are discharged

Before you leave the hospital, make sure that you:

• have written instructions about changes in your dosage of medication or insulin injections and any new medications or treatments;
• have instructions about meal plans and activity levels once you are home;
• know how often to check your blood sugar level (and, if necessary, ketone levels) and what the expected levels should be;
• know what symptoms to watch for once you leave the hospital and know who and when to call for medication adjustments or other medical problems;
• schedule a follow-up appointment to review your progress and your diabetes management.

Your rights and responsibilities

As a patient, you have the right to:

• receive quality medical care from competent health-care providers who know and follow accepted safety standards;
• obtain easily understood information about your diagnosis, treatment, possible outcomes, and your hospital stay in general;
• read your medical file; most institutions have rules to be followed if you would like to see your medical records;
• request a second medical opinion, if you think one is necessary, or talk to a diabetes specialist about your treatment - your doctor can make these referrals for you;
• have the hospital staff respect your knowledge about your condition and listen and act on your concerns if you think certain medical procedures (for instance, the timing of medications or meals) are putting you at risk;
• immediate treatment if you are experiencing low blood sugar;
• receive a copy of the hospital’s patient bill of rights;
• ask for a meeting with the hospital’s Patient Representative or Patient Advocate if you are concerned about your care or if you think your concerns are not being heard.

You have the responsibility to:

• be polite and respectful to everyone involved in your care, even if you are tired, frustrated or uncomfortable - hospital staff will appreciate the courtesy and may even be more willing to listen to you;
• provide accurate information about your medical history, medications you are taking, and your diabetes management plan;
• work as a partner with your health-care team and follow hospital standards;
• report immediately any episodes of low blood sugar, sudden weakness, sweating, shaking, or blurred vision.

If you don't believe your diabetes was handled appropriately in the emergency department or on the hospital unit, you might wish to file a complaint with the hospital, as well as discuss the problems you encountered with your primary care team. Serious concerns can be filed with the provincial College of Physicians and Surgeons.