DIABeducation™ february2006
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
February 2006 

The Choice to Inhale Insulin

The wait to take a deep breath of insulin is almost over for the diabetes community.

Eighty years after learning to successfully inject insulin into the body, researchers discovered how to inhale the life-saving hormone, and obtained FDA approval for Exubera® this January which is expected to be available mid-year.

That’s a long time to wait, but not if you want an alternative way to get rapid-acting insulin into your system.

Exubera® is a mealtime insulin that is taken about 10 minutes prior to eating via an inhaler. According to the manufacturer, a “blister of Exubera insulin” is inserted into an inhaler. A handle on the inhaler is pumped, causing an insulin cloud to be released into the chamber, which is then inhaled by a person breathing normally. The insulin passes from the mouth quickly to the lungs where it is rapidly absorbed.

And that’s a good thing. Millions of people need insulin but don’t take it. Fear of injecting insulin has long been a barrier to obtaining diabetes control and preventing needless complications, especially for those with type 2. Exubera® can be used with diabetes pills.

In addition, the hope is that Exubera® will allow people to receive insulin much earlier in their treatment plan. Hyperglycemia, or glucose values over 200 mg/dl, are rampant for people with diabetes. As a certified diabetes educator, it common to hear people say, “I don’t want to be on insulin — that means my diabetes is really serious! My father was on insulin and lost his leg.” Insulin did not cause the amputation; hyperglycemia did.

Plus, for people with type 1 and type 2 diabetes who need a break from injecting insulin before each meal, the convenience factor can be huge, equating to 1,092 less injections/year.

So what’s the catch with this technological breakthrough? Some potential concerns include:

• The need to inject a long-acting insulin (Lantus or NPH) remains.
• Exubera® may decrease lung function.
• It cannot be used for anyone who smokes (must not have smoked for 6 months prior), or has a chronic lung condition like asthma or emphysema.
• May cause hypoglycemia, just like other insulin products.
• May cause a cough, dry mouth, or chest discomfort.
• Dosing issues (confidence factor of getting the entire intended dose; how to handle when one coughs right after using it or has a stuffed up nose?)
• The taste—does it need cherry flavoring?

Before people can puff the magic dragon of Exubera®, diabetes education will be mandatory. It is smart to learn how to prevent potential problems with inhaled insulin and to have an update on diabetes management.

Until we come up with insulin bath beads, we don’t need to wait to start making healthier choices. There is no substitute for consistent diabetes self-care management, which now has inhaled insulin added to the mix. Exubera® is not a panacea, but it will definitely be useful.

We’ve come a long way from blending up pig pancreases to get our insulin needs met. We have a freedom of choice in finding the key to successful diabetes management. For some, that key will be inhaled insulin.

DIABeducation™ december2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
December 2005

CREATURE FEATURE: THE GILA MONSTER

What reptile eats only a few times a year, has a poisonous venom that causes humans to have an exaggerated insulin response when bitten, and can help people with type 2 diabetes? If you guess the Gila Monster, a lizard native to the southwest, you are correct!

Researchers figured out how to derive the active ingredient from the saliva of the Gila Monster, and in June 2005, the FDA approved Byetta (exenatide), a new class of drug called an incretin mimetic (a hormone released in the gut in response to ingested food).

After decades of research, Amylin Pharmaceutical and Eli Lilly Company developed Byetta which restores first phase insulin response. Normally, the pancreas releases insulin immediately after food is ingested, a response that is diminished with diabetes. Byetta is used for people with type 2 diabetes who are no longer successful at managing glucose levels with oral medications (for example, a sulfonylurea like Glipizide and Glyburide, or a biguanide like Metformin).

Byetta has many positive effects:

• Stimulates insulin only when glucose levels are high
• May reduce the amount of diabetes pills needed
• Safer related to hypoglycemic risk than current treatment options
• Inhibits the release of glucagon after meals (the hormone that causes the liver to release extra glucose)
• Can be used with or without insulin
• Increases the feeling of satiety (fullness) which often results in weight loss

Some disadvantages include:

• Must be injected 60 minutes prior to breakfast and dinner
• Not recommended for people with type 1 diabetes, end-stage renal disease, or people with gastroparesis
• May cause nausea at first, which typically subsides over time

Not all monsters are scary. If you can get past the idea of lizard saliva, Byetta may be the drug that can get your diabetes in control. Ask your healthcare provider if this is an option for you.

DIABeducation™ october2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
October 2005

A Personal Perspective of the Diabetes Prevention Program

Have you ever wondered what it would be like to be involved in a landmark research study? Fate allowed me the opportunity to take a peek inside the Diabetes Prevention Program (DPP), the major study that showed 58 percent of people at high risk for getting diabetes could prevent it. How? By eating less fat and fewer calories, exercising 150 minutes a week (a little over 20 minutes a day), and losing 7 percent of body weight.

While attending the Humor Project conference in April, I randomly met Eugene Goldstein, a humor enthusiast who happened to be enrolled in the Diabetes Prevention Program. We connected recently to discuss his experience in the DPP. Eugene agreed to answer a few specific questions.


Eugene Goldstein

How did you hear about or get selected for the DPP?

By accident. I was at a health fair for business reasons when I learned about the DPP. I figured, “Why not?” They did a blood test, took my history. At the time, in September 1996, I weighed 234 pounds.

What personal insights have you learned by participating in the DPP?

I have a problem with food. Even when I’m full, I still want to eat. I learned I could lose weight. My knowledge about diet and exercise in general increased, as did my knowledge about diabetes. At first, taking 10,000 steps a day would wipe me out. Now I feel better about myself mentally and physically. I learned about the harmful effects of some foods I used to think were OK. For example, a seemingly innocent tuna sandwich. You think it’s healthy, but it turns out not to be so because of the amount of fat in the mayonnaise. I didn’t know about the health of food until I looked it up in DPP manuals given to us.

What would you like to share with others as a result of your involvement with the DPP?

The power of the mind is important. Everyone is different. You have to make a choice at some point. Diabetes is a life threatening situation. I came to the realization that my life depended on it—literally, so I began to change how I ate. Healthy food can taste good. If I had to eat food that wasn’t enjoyable, I wouldn’t bother. Sometimes, the people in your life can be a barrier. Family, friends and co-workers can be a negative force when you are trying to do something positive (“It’s just a little piece of cake—it won’t hurt you”). Also, I advise your readers not to follow any fad diets, or to use food as a reward or as a way to cope. As a result of the DPP, the term impaired glucose tolerance was changed to prediabetes.

Any closing thoughts?

I am thankful for all the people that helped me. I made a lot of changes in my life and the DPP is a great, positive group that helped make it possible. We now meet every three months. Our next meeting is October 29^th when the New York chapter of the DPP, along with lead physician Dr. Sandra Foo, walk across the Brooklyn Bridge. I am amazed more people don’t take advantage of the program.

Thank you Eugene for sharing this one-of-a-kind experience that can make the difference for preventing type 2 diabetes. He is living proof of the Diabetes Prevention Program’s success; you can be successful too.

DIABeducation™august2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
August 2005

Overcoming the Heat

If you’ve never had the pleasure of experiencing the heat and humidity of a blazing summer’s day in Washington D.C., consider yourself lucky—it’s overwhelming. It feels like you don’t stand a chance to walk just one more block to the shelter of an air-conditioned room.

As I return from the American Association of Diabetes Educator national conference held in our nation’s capital, I thought about how diabetes can also be overwhelming, and how sometimes people say they don’t feel like they stand a chance in this epidemic—but you do!

Over the past week, I rubbed elbows with an army of nearly 5,000 diabetes educators from across the globe and heard pearls of wisdom about how we are fighting this disease. May these insights bring you respite from the intensity of diabetes:

• Diabetes is not a death sentence.
• Diabetes is not the leading cause of heart attacks and strokes—uncontrolled diabetes is.
• Your actions make a difference; obey your instincts.
• 85% of diabetes is diagnosed by a primary care physician.
• Obesity is driving the diabetes epidemic. Average adults gain 1.8 pounds per year. To prevent that weight gain, you’d only have to cut out 100 calories a day.
• In the U.S., the average steps taken by men are 5,940, and women take and average of 5,276 steps. With that, we have an average obesity rate of 22.8%. Colorado has the highest average of steps taken per day, about 6,500, and only 16% are obese. With the Amish, average steps taken per day are 16,000 and obesity rates are between 4-9%. Connection? You bet!
• It would take only 2,000 steps a day to prevent type 2 diabetes. Mr. Diabetes is a wonderful example of taking those extra steps.

Ready for more? Read on:

• We need to monitor blood pressure (BP) just as vigilantly as we do blood glucose levels. Go pick yourself up an Omron BP monitor. It’s accurate and can save your life. (Omron also makes a wonderful pedometer.)
• Fear of hypoglycemia is the main cause of not being in tight control.
• 12 year olds average 2-4 cans of soda/day (comprising roughly 20% of total daily calories).
• Less TV viewing means weight loss for adolescent girls, but not boys.
• 30 years ago, 66% of children walked or biked to school. Today, 13% do. In Marin county California, a “walking bus” program was started and increased the number of kids walking to school to 64%.
• 70% of your self-talk is negative. Attitude is latitude. Think positive!

As my year as the national Diabetes Educator of the Year passes, I am renewed with a sense of passion from my colleagues whose mission in life is also to be that place of refuge for people with diabetes. The new Diabetes Educator of the Year, Mary Bowens from Mississippi, will carry on the torch of spreading joy across the nation, inspiring other diabetes educators to make that diabetes difference. And if you ever feel overwhelmed, remember, there is a diabetes educator close by, like a breath of fresh air.

DIABeducation™ june 2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE
May 2005

Those Who Laugh, Last

A recent patient, whom I shall refer to as “Shirley,” shared a wonderful story about her grandmother’s insistence that the family use daily laughter.

About 70 years ago, Shirley’s grandmother, May, made the entire family go to the basement before breakfast, to listen and laugh to a waxed-cut record of a laugh track, every day. It’s hard to imagine doing something like that today, let alone in the 1930s. Well, Shirley and her young sister made a pack on a regular basis while clasping pinkies, “Promise—we will NOT laugh today!” Sure enough, morning would role around and to the basement the family went. And without fail, everyone would eventually crack up.

Shirley pleaded with her grandmother, “Why? Why do you make us do this?” to which May replied, “You feel better, don’t you? Laughter is the best medicine going!”

May was right. Laughter is the best medicine. The literature proves that laughter:

• Lowers glucose
• Improves immune function
• Reduces stress and burnout
• Releases endorphins
• Improves learning and communication
• Reduces pain
• Is used as a weight loss therapy

Humor is a must for anyone’s health. The research data proving that point is growing by leaps and bounds. We have Norman Cousins to thank for starting this relatively new field of medicine in 1964, called psychoneuroimmunology, or the mind-body connection. At that time, he was the editor for the Saturday Review when he was diagnosed with a debilitating condition called ankylosing spondylitis, which essentially left him bedridden. He was given a prognosis of 3 months to live.

Norman accepted the diagnosis, but not the prognosis. He postulated, “If negative thoughts have been proven to cause negative physiological repercussions in the body, what about positive thoughts? Would positive thoughts produce positive physiologic results within the body?” So he checked out of the hospital and prescribed high doses of humor by watching several comedy shows a day and making it a point to laugh. He recovered and returned to his editorship at the Saturday Review.

The research solidly backs up his suspicions on the healing power of humor. And May was way ahead of her time. Did you know that there are about 1,000 laugh clubs world wide? That’s where people meet, and listen and laugh to laugh tracks for about 30 minutes. They’re not listening to comedians—they are just laughing, reaping the benefits it has to offer.

In tribute to Shirley’s grandmother, May, I went on-line and found a laugh track. Once it arrives, I plan to intentionally set aside time to just laugh. I also plan to bring it to work so my colleagues can join in for a laugh break. I can’t wait. Plus, I want to look as good as Shirley, who is in her 80s.

Have you had your good laugh for the day? It’s never too late to start and you don’t have to have a basement for it to work. And let me know how it affects your glucose levels.

DIABeducation™ april 2005
April 2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Vacation Time

The sun is out and flowers are blooming. Do you find yourself suffering from Spring fever? Not to worry—the remedy is easy. Decide on a nice place to visit to take a little time out from the hectic pace of life. What better way to recharge oneself?

So while you are packing those suitcases, remember to pack along your diabetes care supplies. You can get into a lot of trouble on vacation if you attempt to completely forget about diabetes. Here are some travel tips to help ensure a wonderful holiday:

Pre-Planning

• See your healthcare provider for a check-up about one month prior to a long trip.
• Get a letter from your doctor explaining you have diabetes, what medications you are taking, including the need for insulin and insulin syringes if that is your situation, and the necessity for blood glucose monitoring and supplies.
• Ask about immunizations if you are traveling abroad.
• Ask your doctor how to adjust your medication with time zone changes.
• Ask your doctor to advise you what to do if you get ill on your trip (what medications to take for vomiting or diarrhea, for example).
• Have your doctor fill out extra prescriptions for medications, insulin, syringes, lancets, and strips so if your supplies are lost or stolen, you will have an easier time getting them replaced.

Packing

• Diabetes supplies should be carried on to avoid loss and potential temperature issues if medication is stored in checked in baggage (especially true with insulin).
• Medications and insulin with their original pharmacy labels on them.
• Blood glucose monitor (allowed if clearly marked with the brand name and the lancets are properly stored in the case).
• Carry a few snacks, like crackers with cheese or peanut butter, along with juice and/or glucose tablets, and a protein bar.
• Bring twice the amount of diabetes supplies as you think you will need.
• Shoes and socks that won’t cause blisters.
• Medical insurance cards and emergency contact numbers.
• Medical alert bracelet for those taking insulin or diabetes medications.
• Insulated bag to keep insulin cool.

Airline considerations

• Call the airline at least 24 hours in advance to see if there are any additional requirements in carrying your diabetes supplies on board.

• Syringes and blood glucose monitors are allowed if properly labeled.
• Don’t worry about having your meter or insulin X-rayed.
• If you have trouble getting through security, ask for a supervisor to assist you.
• Ask for a diabetic meal or count your carbs and order a regular diet.
• Request an aisle seat so you have easier access to the bathroom.
• If traveling alone, tell at least one person you have diabetes.

Having diabetes is complicated enough as it is. With a little careful planning, you can enjoy a safe, relaxing time on holiday. Surf’s up! Don’t forget your camera and sunscreen!

DIABeducation™ february 2005
February 2005
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Something To Smile About

Brush your teeth! Mom was right. And especially if you have diabetes. 

Did you know that gum disease (periodontal disease) is the most common oral complication of diabetes? Under conditions of high blood glucose (hyperglycemia), tissues surrounding the teeth are prone to swelling and inflammation.

Do you have any of these signs or symptoms?

• Red gums that tend to bleed easily
• Bad breath
• Tender mouth
• Loose teeth
• Pain
• Unexplained hyperglycemia

Periodontal disease often has no symptoms which may give you a false sense of security regarding your dental health. If you don’t see a dentist regularly (the recommendation is at least every 6 months), your diabetes may suffer as a result with unexplained high glucose levels. This in turn, increases the amount of medicine needed (or insulin required for those taking insulin) to control the hyperglycemia.

How can you reduce your risk for periodontal disease?

• Brush teeth and floss regularly
• See the dentist

·      See the hygienist for professional plaque removal

• Keep glucose levels near normal
  (70-120 fasting, and less than 150 two hours after a meal)
• Maintain adequate nutrition
• Decrease intake of sugars
• Take a multivitamin (if approved by MD)
• Stay hydrated

When is the last time you saw a dentist? Dental care is an important part of health. If you are taking insulin or pills that make your pancreas release more insulin (Glipizide, Glucotrol, Prandin, Amaryl, Glyburide, to name a few), it is recommended to schedule dental appointments about 1 hour after a meal to reduce the risk for low blood glucose (hypoglycemia, less than 70). Check with your dentist about any potential timing issues with your diabetes medication.

With these few simple tips, you can prevent gum problems. And you’ll have the teeth to smile about it!

DIABeducation™december
December 2004
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Counting Blessings

'Tis the season to be jolly and count our blessings. But what's so jolly
good about having diabetes? The answer to that question resides in one's
ability to see the silver lining in life. Do you see the proverbial glass
half full or empty? Do you tend to accentuate the positive in everyday
circumstances?

Knowing you have diabetes is a gift. We don't always get a second chance at
health. With diabetes, you get the chance to be healthy - maybe not by
choice, but out of necessity. I have had many people say to me after they
received diabetes care and education that, "Getting diabetes was a blessing.
I've never been healthier." That statement is somewhat of a dichotomy. Most
people think that you cannot possibly have diabetes and be healthy.

Unfortunately, half of the people with diabetes don't know they have it. As
Andy Mandell, Mr. Diabetes®, of Defeat Diabetes Foundation says, "The one
thing worse than finding out you have diabetes is not finding out you have
it." In the spirit of giving this season, give yourself the gift of health.
If you need help with managing your diabetes, physicians and diabetes
educators can help.

Step back and take a quick inventory of your blessings. What areas in your
life bring you joy? What people make a difference in your life? Diabetes is
a small part of who you are. Be sure to recognize all the things that are
meaningful. This holiday, shift your focus from counting carbs to counting
your blessings. I bet you have many to count.

DIABeducation™october
October 2004
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Recipe For Diabetes Health

Do you like to follow recipes? A recipe is merely a formula for success. It requires measuring, following certain steps, taking a little more care in creating something wonderful so you can pretty much guarantee the outcome.

We have the recipe for diabetes health! We know the numbers and actions needed to prevent and in some cases, reverse complications typically associated with uncontrolled diabetes. So, how are we doing? According to information shared during the annual American Association of Diabetes Educators in August 2004, less than 2% of people with diabetes have the four main ingredients for diabetes health.

How can that be possible? The answer to that is somewhat complicated. Most people with diabetes see a primary care physician to manage their diabetes, that is, if they are lucky enough to have some type of health care insurance. The average visit in a doctor’s office is 7 minutes. Studies show that many physicians do not know the target ranges for key diabetes tests. Having a physician who is able to oversee and successfully tackle all key areas is a challenge. Plus, it is not all up to the physicians. People with diabetes are responsible for 95% of their daily management. Since less than half of people with diabetes ever see a certified diabetes educator, it is no wonder people are unaware of the ingredients for diabetes health!

The 4 main ingredients:

• A1C less than 7% (the blood test which shows a three month blood glucose average); check at least twice a year if in control or every 3 months if your level is not less than 7%.
• LDL cholesterol (low-density lipoprotein) less than 70. This is commonly referred to as the “bad” cholesterol and a high level increases the risk of heart disease. Check at least once a year, more if not in control.
• Blood pressure less than 130/80. Check every visit with your doctor. In my daily practice, I hear time and time again, “It’s only high when I go to the doctor. It’s fine at home.” If it is above 130/80 at the doctor’s office when you are under a little stress, it is high other times, just not being measured. Get a home blood pressure cuff and monitor yourself.
• Baby aspirin, 81 mg daily (caution: get your doctor’s approval before starting aspirin therapy).

This recipe is may require you get some assistance from the experts. No, not the gourmet cooks, but the certified diabetes educators and your healthcare team of physicians who can partner with you to cook up the perfect picture of diabetes health!

DIABEducation™
August 2004
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

The Golden Pancreas Award

Move over Hollywood. The American Association of Diabetes Educators (AADE) took center stage this August at our national convention in Indianapolis.

The red carpet was rolled out to celebrate our efforts as certified diabetes educators (CDEs) and provide over 130 courses from internationally renowned speakers on the latest research and approaches to care. Out of over 10,000 CDEs in the United States, I was honored to receive the prestigious Diabetes Educator of the Year award and the Allene Van Son award for best audiovisual education tool for my diabetes cartoons.

Wait! Slam on the brakes! Have you not heard about AADE? The AADE is the leading authority in diabetes self-management training and in lifestyle management for the prevention of diabetes.

So, why aren’t AADE and diabetes educator household names? Visibility. At the conference, we were hard to miss with over 6,000 attendees. At home, in your community, do you know your diabetes educator? We have a passion for making a difference in helping people live successfully with diabetes, that is, for the ones lucky enough to meet us (67% of people with eligible Medicare coverage do NOT see their CDE. For a list of CDEs in your area within the U.S., call 1-800-832-6874.

In addition to the incredible recognition I received, I also learned many cutting-edge research findings and startling facts:

• The U.S. national average A1C level (a blood test that measures a 3-month blood glucose level) is a staggering 9.5% (7% or less is the target range to prevent complications)
• 30-40% of people with hyperglycemia (high blood glucose levels) leave the hospital with undiagnosed diabetes
• Less than 2% of people with diabetes have reached the goals for blood pressure, cholesterol, A1C and daily aspirin use (this is worthy of a separate column; talk with your doctor before starting aspirin)
• Less than 3% of people with diabetes see an endocrinologist (a diabetes specialist)
• The average doctor’s visit is 7 minutes
• Half (50%) of heart attacks are caused by a bacteria called Chlamydia pneumoniae which camps out in the coronary artery (more on this in an upcoming article)
• The 30-39 age group has a 70% increase in the rate of diabetes (the highest rate of any age group)

What is the solution to a seemingly insurmountable, uphill battle? Give power to the people. As Ann Albright, Ph.D., R.D. says, CDEs are the ambassadors and communicators in local, state and national levels, and we need your help:

• Get involved locally and spread the word about diabetes education and its virtues
• Ask your doctor for a referral to see a CDE
• Call your local government officials to sponsor pending diabetes-related federal legislation (HR 3194 and Senate Bill 2431) which will improve access to diabetes educators

My goal as Diabetes Educator of the Year is to increase our visibility. With the help of a generous $10,000 grant from LifeScan and support from AADE, I will fly across the U.S. to lecture and collaborate with other CDEs. As I stood in front of thousands of fellow diabetes professionals to accept the awards, I took a picture of the audience. We are one in terms of our mission. With over 18 million people with diabetes and 41 million pre-diabetics in the U.S. alone, AADE should be on the cover of People magazine! I wish to extend a special thanks to Defeat Diabetes Foundation for recognizing the value of CDEs and the benefits of diabetes cartoons.

My hope is that “diabetes education” will be as recognized as any Hollywood movie stars’ names. Although I won the proverbial golden pancreas award, I invite you to join us in getting the word out about diabetes education. You can save someone’s life.

Remember the sage words of Margaret Mead, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

DIABEducation™
June 2004
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Prevention is Bliss

When the traffic light turns yellow, do you slow down to avoid an accident? What if the warning signs of a serious health problem were as obvious? It is with diabetes, thanks to a new standard for defining high blood sugar and pre-diabetes.

What is pre-diabetes? It is a health condition wherein blood sugar (glucose) levels are elevated, but not high enough to be classified in the diabetes range. How high is too high? According to the new American Diabetes Association standard set in November 2003, pre-diabetes is defined by:

• A fasting blood sugar (taken in the absence of food/drink for at least 8 hours) more than 100 and less than 125 milligrams, or
• A random blood sugar (taken anytime of the day regardless of food/drink consumption) of more than 140 and less than 200 milligrams.

How do you find out if you are one of the 41 million North Americans who have pre-diabetes? A simple blood sugar test performed by your doctor! Who should get tested? Anyone who is:

• 45 or older and overweight (ask your doctor about the test if you are not overweight)
• 30 or older if you have a diabetic relative, are overweight, belong to African American, Latino, Asian, American Indian or Pacific Islander populations, have high blood pressure, high cholesterol, had gestational diabetes, or if you had an abnormal blood sugar reading in the past.

If you have pre-diabetes, you can prevent belonging to the growing diabetes epidemic by walking or being active almost every day and losing a little weight (7% of your total weight). Preventing a chronic disease—that’s bliss!

Slow down and get tested for diabetes. What you know can save your life.

DIABeducation™
April 2004
By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Hospitalization: The Good, The Bad and The Ugly

No one likes hospitalization, but being prepared makes a difference. Did you know people with diabetes have higher rates of hospitalization, an average stay of 5.4 days, and require more services than for people without diabetes?

According to a landmark review, “Management of Diabetes and Hyperglycemia in Hospitals” published in Diabetes Care at least 25% of hospitalized adults have diabetes. That’s a lot of people! This review clearly showed high blood glucose levels (hyperglycemia) are associated with poor hospital outcomes. So what is hyperglycemia?

• A fasting glucose more than 126, or
• A random glucose more than 200

Two major recommendations in this article will shock most nurses and physicians:

• Maintain glucose levels less than 110 before meals and less than 180 after meals
• Scheduled insulin (instead of sliding scale used alone) or intravenous insulin improves recovery

What can you do?

1. Bring or be your own advocate. Be ready to educate the healthcare team. You know your diabetes best.
2. Ask questions about your glucose levels and medications. Some diabetes pills are stopped prior to surgery. Stress can raise glucose levels, even when not eating. Insulin is often needed to control diabetes in the hospital.
3. Use the hospital’s resources. Request an endocrinologist (diabetes specialist doctor) referral. See the diabetes nurse educator or dietitian to help with specific concerns.

The bad and ugly aspects of hospitalization can turn to good, with some planning and vigilance. It’s like disaster planning — if it hits, you’ll be ready.

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