Glucose Monitoring and Discharge Planning Glucose Monitoring Recommendations
ÎSMBG should be carried out three or more times daily for patients using multiple insulin injections or insulin pump therapy. (B)
ÎFor patients using less-frequent insulin injections, noninsulin therapies, or medical nutrition therapy (MNT) alone, SMBG may be useful as a guide to management. (E)
ÎTo achieve postprandial glucose targets, postprandial SMBG may be appropriate. (E)
ÎWhen prescribing SMBG, ensure that patients receive initial instruction in, and routine follow-up evaluation of, SMBG technique and their ability to use data to adjust therapy. (E)
ÎCGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. (E)
Diabetes Self Management Education (DSME)
ÎDSME cannot wait until discharge, especially in those new to insulin therapy or in whom the diabetes regimen has been substantially altered during the hospitalization.
ÎReview and address the following areas of knowledge prior to hospital discharge:
> Identification of health care provider who will provide diabetes care after discharge > Level of understanding related to the diagnosis of diabetes, self-monitoring of blood glucose, and explanation of home blood glucose goals
> Definition, recognition, treatment, and prevention of hyperglycemia and hypoglycemia > Information on consistent eating patterns > When and how to take blood glucose–lowering medications including insulin administration (if going home on insulin)
> Sick-day management > Proper use and disposal of needles and syringes
Discharge Planning
ÎDiabetes discharge planning is part of an overall discharge plan that begins at admission and is updated as patient needs change.
ÎInpatients may be discharged to varied settings, including home (with or without visiting nurse services), assisted living, rehabilitation, or skilled nursing facilities.
> Discharge planning to the latter two sites can be limited to communication of medication and diet orders to the health professional staff.
> For the patient who is discharged to assisted living or to home, the optimal program will need to consider the type and severity of diabetes, the effects of the patient's illness on blood glucose levels, and the capacities and desires of the patient.
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