Hospital challenges
Managing diabetes can be more of a challenge in the hospital for several reasons. Changes in mealtime routine play a big role: If you’re in the hospital, you will probably eat different foods—at different times—than you do at home. So, you may have to adjust your usual schedule for taking diabetes medications.

Another problem is that many hospitals use an out-of-fashion “sliding scale” insulin-dosing system for patients with diabetes. In this system, a healthcare provider monitors your blood glucose levels throughout the day, and then uses some simple math to calculate each insulin dose. Doses may “slide” higher or lower, depending on each blood glucose reading.

The sliding-scale system allows the person to receive insulin as soon as high blood glucose is recognized. The downside is that a high glucose level is not prevented—it is only treated after it occurs. Treating high blood glucose after it develops—rather than keeping glucose on an even keel with steady doses of insulin throughout the day and night—can cause sudden, dangerous swings in glucose levels. One study found that among people who were treated using only the sliding-scale system, blood glucose levels were three times higher than they were in people who received the more generally used injections of intermediate-acting insulin and/or diabetes pills.

Prepare for your care
If you know ahead of time that you’ll be entering the hospital, be sure that everyone who will be involved in your treatment and care is aware that you have diabetes. Ask your doctor whether standard insulin injections should be started for you, rather than your having to rely on the sliding-scale system that the hospital might use. Injections may include a base (basal) dose of long-acting or intermediate-acting insulin, with short-acting or rapid-acting doses given at mealtimes.

You also should know your target glucose levels so that you can alert someone before they rise too high or fall too low. A group of doctors who specialize in diabetes—the American Association of Clinical Endocrinologists—puts the target blood glucose levels for people in intensive  hospital care at 80 to 110 milligrams per deciliter (mg/dL) of blood. In non-critical patients, pre-meal glucose levels below 110 mg/dL are okay, while levels taken at different times of the day should be less than 180 mg/dL.