Let’s face it. Almost no one looks forward to a stay in a hospital. But there may come a time, whether you have scheduled minor elective surgery or are in the throes of an emergency, when you need to check into a hospital. You may be nervous about this and not like the feeling that you have no control. You are out of your normal routine and may worry about how long you will be there, how quickly you will recover, and whether or not your diabetes will be adequately cared for.
Even though you are not sick now and don’t plant to be anytime soon, anything could happen at any time. The best time to plan your hospital stay is before you even have the need. Taking the time now to think about your hospital stay will go a long way in making sure you get the best possible care.
What You Should Do
The first thing to do is to choose a hospital. You can’t always choose a hospital in an emergency situation. It is best to do the legwork now, not when you have other things on your mind. Start by finding out where your doctor has privileges. Ask your doctor if she has a preference or would recommend one hospital over the other. One hospital may be more experienced in dealing with people with diabetes, for example, or may be better equipped to handle emergencies. Ask your doctor where she would send a family member.
Depending on where you live, your choices may be restricted. You may live in an urban area with dozens of hospitals nearby, or there could only be one hospital within an hour’s drive. If you do have a choice, consider what kind of hospitals are available. In general, three kinds of hospitals are available:
Sometimes there is overlap. A county or city hospital could be affiliated with a medical school.
If your doctor strongly recommends a particular hospital, that may be enough to help you decide. But you can also seek other opinions. Ask your friends, neighbors, or relatives who have had recent hospitalizations about their experiences. Check with your diabetes support groups to find out more about your local hospital’s reputation. Also ask your health insurance provider which hospital’s services will cover and whether there is any restriction on the choice of hospitals. Many insurance companies require that you let them know in advance of any scheduled inpatient or outpatient hospital visit. Often, you must be pre-certified in order to have the services covered, unless there is an emergency situation.
When choosing a hospital, find out if there are any endocrinologists on staff. Endocrinologists specialize in hormonal disorders and are experienced with treating diabetes. Find out whether the hospital has diabetes educators or dietitians on staff who have experience working with people with diabetes and whether they are available to both inpatients and outpatients. Also find out whether the hospital sponsors any diabetes education programs, support groups, or other types of support services.
Once you are in the hospital, it is important to communicate your needs as a person with diabetes to both admitting personnel and clinical staff. If you are not in any condition to communicate directly, make sure that a family member or friend can speak up for you. Make sure that the doctors and nurses taking care of you know that you have diabetes. Tell them what medications you are currently taking. Write a list ahead of time that includes all your medications, how often you take them, and in what doses.
If you have any other conditions, such as allergies or complications of diabetes, be sure to tell your attending staff. If you have high blood pressure, you may require special treatment before surgery, for example. If you take any heart medications, these may need to be adjusted. If you are prone to hypoglycemia, make sure to let them know. If possible, bring your blood glucose monitoring records with you. Also tell them about your meal plan. Ask to meet with the hospital dietitian and discuss your particular dietary records.
With enough advance planning that allows you to investigate your hospital and provide them with enough information about you and your diabetes care plan, you can ensure that your hospital stay goes as smoothly as possible.
Surgery and Anesthesia
The thought of surgery can make you nervous. Even the most routine outpatient surgical procedures are not without their risks. If you have diabetes, you can expect to recover as well as anyone without diabetes. However, you may find that maintaining blood glucose control during and immediately after surgery can be tricky. That’s because surgery imposes a major stress on your body. And the way your body reacts to stress is to secrete hormones that trigger the release of glucose into the bloodstream and inhibit the effects of insulin.
The net result is that blood glucose level can rise. It is important that your medical staff takes steps to keep your blood glucose levels under control to avoid any complications. You can help the process by maintaining good blood glucose control before your surgery.
Unless you are having emergency surgery, the first question to ask is whether you really need it. If your doctor recommends surgery, make sure to take the time to discuss your options with her. Ask your doctor whether there are any alternatives and what will happen if you elect not to be operated on. Also discuss the risks involved. No surgical procedure is without risk. Ask what tests and other procedures you might be expected to go through in conjunction with the surgery. Also find out whether you will be under the care of your primary care physician in the hospital or whether you will be seen by a doctor on staff at the hospital. If you will see other doctors, do they specialize in diabetes? Make sure to get all your questions answered before agreeing to any elective surgery.
Of course, if after discussing your surgery with your doctor, you are still unsure or have reservations, feel free to seek a second opinion. Anytime a doctor recommends a surgery, a long-term medication, or other treatments that may affect your lifestyle, it is a good idea to think about getting a second opinion. You may also want a second opinion if your doctor tells you that your condition is incurable or there is not therapy that can help you.
If you are considering surgery, ask your insurance company if they will pay for the procedure that is being recommended. Also ask if they will pay for a second opinion. Some insurance companies will require a second opinion before they will fully cover any surgery. And some insurers will reimburse you for the expense of seeking a second opinion. Also ask the insurance company if they will only pay for a second opinion if you see one of the doctors they recommend.
It is not always easy to figure out who to ask for a second opinion. Don’t ask your doctor whether you need a second opinion. But if you have reservations, tell your doctor you like a second opinion. Ask your doctor or another doctor you trust to recommend someone with whom you can consult. Look for a doctor who is board-certified in the field in which you are seeking information. For example, if you are considering heart surgery, find someone who is board-certified in cardiology or surgery. The person answering the phone will be able to tell you if the doctor is board-certified.
Make sure that the physician with whom you are consulting knows that you have diabetes.
When you seek a second opinion, here are some things you might want to ask:
Once you decide on surgery or a particular treatment, and if time allows, try to work with members of your health care team to achieve good blood glucose control. The better your general state of health, the better your chances of withstanding the stress of surgery. This will help reduce the chance of developing infection and will help speed your recovery.
However, if you are brought into the hospital for emergency surgery or if your blood glucose levels are not well controlled, don’t panic. The medical staff will take great care in keeping your blood glucose levels within an acceptable range for surgery. This may be done through intravenous insulin and a glucose drip that will be monitored throughout surgery.
If you routinely keep your blood glucose levels under good control, your doctor will probably not recommend any changes in your diabetes care routine before you enter the hospital. However, you can expect that once you enter the hospital, the staff will keep close tabs on it. Don’t be surprised if your blood glucose levels swing once you have been admitted.
This can occur as a result of the stress or anxiety in anticipation of surgery, your medical condition that is making the surgery necessary, and the changes in your eating and exercise routine that occurs when you check into the hospital. Don’t be surprised if you are put on insulin, even if you are used to controlling your diabetes through diet and exercise alone or with the help of oral agents. It is usually a temporary measure and once you recover, you will probably resume your normal routine.
If you are given insulin, you may be prescribed several injectable doses each day. If you are already using insulin, don’t be surprised if your dose is increased. Some doctors may prefer to give you a continuous infusion of insulin intravenously. You will probably also be given glucose intravenously. This allows your medical staff to keep your blood glucose levels stable by checking them frequently and making adjustments in insulin and glucose infusion rates.
Don’t panic if your blood glucose levels are kept higher than what you are used to. This may be done deliberately to avoid the risk of hypoglycemia. Most doctors think that keeping them a little higher than normal is preferable, as long as they don’t go over 200mg/dl. However, if you feel any symptoms of hyperglycemia or hypoglycemia, make sure to tell your nurse or doctor right away.
Before any scheduled surgery, you should expect to meet with your surgeon at least once before your operation. The surgeon should explain the surgery and what you should expect afterwards. If possible, keep a list of questions to ask the surgeon beforehand. Nurses will also be on hand to answer questions you may have.
The anesthesiologist will also visit you to tell you what you should expect. During any kind of surgery, you will be given anesthesia, or a pain killer, so that you don’t feel pain. Your anesthesiologist is a doctor who specializes in administering anesthesia. Under certain circumstances, you may have choices in anesthesia, and these should be explained to you. For most major operations, and many minor ones, you will be given a general anesthesia. This means you will be asleep during the entire procedure.
Many general anesthetics, however, can cause blood glucose levels to rise. You will be given an anesthetic that will be less likely to disrupt your metabolism and blood glucose control. Many physicians prefer a local anesthetic for surgery, but this depends on the type of surgery you are having done. Epidurals, spinal taps, and other locally administered anesthetics are less likely to cause hyperglycemia. Many doctors also prefer dealing with a patient who is awake, because there is a greater chance that you will notice any symptoms of hyperglycemia or hypoglycemia should they occur. Don’t be afraid to ask your anesthesiologist questions about what to expect during surgery and about how the anesthesia will affect your blood glucose levels.
After surgery, you may be switched from intravenous insulin to subcutaneous insulin. Depending on the operation, you may be able to eat right away. In some cases, you may not be able to eat for several days. You may require intravenous feeding and will be given a continuous infusion of glucose. Your blood glucose levels should be monitored frequently. It is important to keep tight control of your blood glucose levels during this period to avoid the possibility of infection and other complications.
Accidents and Emergencies
If you are faced with a medical emergency or are a victim of an accident, you don’t have the luxury of advance preparation. Depending on the extent of your injuries, you may require major surgery or a relatively noninvasive hospital stay to ensure that you are stable
What You Should Do
If you are involved in an accident or other emergency situation, you will probably not have any choice in hospitals. You will be taken to the nearest hospital that can provide the care you need. If you are conscious, make sure to tell the attending medical personnel that you have diabetes. That may influence their decision about where to take you. Make sure to always wear some sort of jewelry that identifies you as a person with diabetes, in case you are not conscious. If you do have a preference of hospitals, tell those in attendance in the event that they can take you there. Also, make sure that those close to you know to tell anyone about your diabetes, should an emergency situation arise.
If you have been in an accident, it is very likely that your blood glucose levels will swing widely. Even a relatively minor accident can stress the body. As long as your medical personnel are aware that you have diabetes, they will make every attempt to bring your blood glucose levels under control.
The combination of trauma and any other emergency procedures will most likely cause your blood glucose levels to rise. Don’t panic. You will probably be given intravenous insulin and glucose and your blood glucose levels will be monitored frequently. If you are able, any information that you can give your medical personnel about your diabetes care, insulin or medication schedule, or how you control your blood glucose will help them better attend to your situation. Also, tell them if you have any diabetes complications, such as heart disease, kidney disease, or neuropathy. Once in a hospital setting, the staff can keep close tabs on your blood glucose levels as they tend to your injuries.
Of course, the better your general state of health and the better your blood glucose control, the better your chances of surviving any accident or medical emergency. In addition to wearing a medical ID tag, consider keeping information on your diabetes care and important aspects of your medical history, including any medications you currently take, on hand at all times. Any information you can provide in an emergency setting will help the medical staff attend to your needs.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification by P Arnold, A Hutto et al