Preparing for a hospital visit 24 April 2017 It’s important to plan ahead if you are living with diabetes and need a medical procedure done that requires day surgery or a hospital visit. Make sure to ask your doctor or diabetes health care team about any special considerations prior to the day. Looking after your diabetes before, during and following a procedure or surgery can help prevent complications, such as infections and delayed wound healing. It is important that everyone involved in your procedure and hospital stay are made aware that you have diabetes, how you look after your diabetes and the contact numbers of your Endocrinologist or diabetes health care team. I am taking oral medications for my diabetes. Will I need insulin in hospital? Sliding scale insulin (insulin doses that slide or move up and down in conjunction with the direction your blood glucose moves) is frequently used in hospital to look after high blood glucose levels. Diabetes is harder to look after in hospital due to the effect of counter regulatory hormones such as catecholamines, cortisol, growth hormone and glucagon which are released in response to stress, illness, infection and pain. Sliding scale insulin can be an effective way to look after high blood glucose levels whilst in hospital however once discharged you will likely continue on your regular medications and stop the insulin. Can I use my insulin pump in hospital? Using your insulin pump in hospital will depend if the hospital has a policy in place for the use of insulin pumps. If your cognitive ability is affected by illness or medication you may not be able to perform the necessary tasks associated with using your pump. Ask your doctor how they plan to look after your blood glucose levels during your hospital stay. Check if you need to detatch your insulin pump before investigations such as medical imaging. If you are able to use your insulin pump in hospital make sure you take any extra supplies you might need. Hospitals may not have access to pump supplies. What happens if I need to fast before my procedure? If you are having an anaesthetic you will need to fast before the procedure, have nothing to eat or drink. It is important to ask your doctor or diabetes health care team for any special instructions in regards to adjusting your insulin or oral medications. You are at a higher risk of experiencing hypoglycaemia (low blood glucose levels), ask your doctor or diabetes health care team how to prevent and/or treat hypos. Ask where you are placed on the surgical list, the earlier your procedure, the less disruption to your diabetes routine. Make sure your diabetes health care team or treating doctor provide written instructions for you to follow while fasting, especially in regard to medication and/or insulin dosage. Information on treating hypoglycaemia can be found here. Do I need to check my blood glucose levels more often? It is a good idea to check your blood glucose levels more often before and after your procedure/surgery. Blood glucose levels often go up in response to stress, illness, infection and pain. Looking after blood glucose levels will help recovery and reduce the risk of complications, such as infection. Ask your doctor or diabetes health care team what your target blood glucose levels should be and how often you should test. Will my oral medications need to be changed? Oral medications may need to be changed prior to your procedure or surgery, especially if you are taking Metformin, Diabex, Diaformin, Glucophage, Metex, Formet, Forxiga or Jardiance. Ask your doctor how long before your procedure or surgery you will need to stop these medications. This will only be temporary and the medications are usually resumed 24-48 hours post surgery. You may also require more oral medication or insulin after discharge if blood glucose levels are higher than normal. This may also be temporary while you are recovering. What if I still feel unwell once I have returned home from my procedure/surgery? It is important that you let someone know (family or friend) when you will be home following your procedure/surgery so they can check on you regularly. Make sure your first aid kit is well stocked before you go in for you procedure/surgery. Consider pain relief, electrolyte replacement drinks and hypoglycaemia treatment. Ensure you have contact numbers available too, such as your Endocrinologist/doctor, diabetes health care team and local hospital. Check your blood glucose levels more frequently and keep taking your medications and/or insulin. If you are vomiting or unable to eat let your doctor or diabetes health care team know straight away. If you are taking insulin, expect your dose to increase if you are still feeling unwell or in pain. If you have type 1 diabetes, always check blood ketones if your blood glucose level is over 15mmol/L and you are feeling unwell. Drink plenty of fluids and keep eating if possible. Seek urgent medical care if needed. If you would like to speak to a Diabetes Educator about your upcoming hospital stay, call our Helpline on 1800 177 055.