Inpatient diabetes management often differs from outpatient diabetes management, especially for patients who have type 2 diabetes mellitus. The most important aspect of inpatient diabetes management is insulin administration. Patients typically are given doses of long-acting insulin either once or twice a day, and are also given doses of insulin before meals and before bedtime based on their blood glucose levels. Often oral diabetes medications are stopped in the hospital because they can cause hypoglycemia, or low blood sugar, and harmful medication interactions. Critically ill patients in intensive care units are often treated with intravenous insulin given continuously at a low rate.
The mainstay of inpatient diabetes management is insulin. Most patients with diabetes are started on a so-called "sliding scale" regimen of insulin administration. Blood glucose levels are checked before each meal and before bed, and insulin is given according to the blood sugar level. Often patients are also given long-acting insulin preparations either once or twice a day in addition to the sliding scale insulin doses.
Often, patients with type 2 diabetes mellitus take a number of oral medications in order to control their disease. As part of their inpatient diabetes management, many of these oral medications are stopped in favor of insulin administration. The main reason for this alternative approach is that continuing the oral medications could put patients at risk for hypoglycemia, or low blood sugar. Many of the oral medications can also interact with other medications administered in the hospital, causing an increased risk for developing medication side effects.
Patients with type 1 diabetes mellitus typically require fewer changes to their diabetes treatment regimen after being admitted to the hospital. At home they typically take long-acting insulin preparations either once or twice a day, and then also take short-acting insulin prior to their meals. The same concept of insulin administration is maintained in the hospital. One exception is that the doses of the insulin are often reduced because patients typically eat less in the hospital, either because they don’t feel well or because they have to fast in preparation for different procedures.
Another important aspect of inpatient diabetes management is the treatment of critically ill patients who are in intensive care units. Many physicians want to try and control the blood glucose levels of these patients carefully. As a result, they might give low doses of insulin continuously, administered through an intravenous line. The dose of this insulin can be changed according to the patient’s blood glucose level, which is typically measured at least every hour while being on this intense regimen.
