Quality Standards for Diabetes Care Toolkit

Self-monitoring and managing own insulin

The Joint British Diabetes Societies for Inpatient Care Group (2012) provide recommendations on how to implement self-management in hospital, including pump therapy.
Key points include the following:

Allow patients to self-manage their diabetes as soon as possible, where appropriate.

The ability of the patient or carer to manage the diabetes should be taken into consideration. Discuss with the diabetes specialist team if necessary.

Prescribe and administer insulin in line with local policies and guidelines, in consultation with the patient wherever possible.

Involve the diabetes specialist team if diabetes-related delays in discharge are anticipated.

Provide patient education to ensure safe management of diabetes on discharge.

Discharge should not be delayed solely because of poor glucose control but appropriate transfer of care and follow-up should occur.

Systems should be in place to ensure effective communication with community teams, particularly if changes to the patients’ preoperative diabetes treatment have been made during the hospital stay.

Diabetes expertise should be available to support safe discharge and the team that normally looks after the patient’s diabetes should be contactable by telephone (www.leicestershirediabetes.org.uk/uploads/123/documents/NHS%20Diabetes%20selfmgt%20of%20diabetes%20in%20hospital.pdf).
The recent American Diabetes Association technical review also refers to inpatient self-management of diabetes. To implement the recommendations proposed therein, patients would have to be well-informed before admission and not in need of basic education. According to Nettles (2005), the technical review’s recommended components for safe inpatient self-management include:

demonstration that the patient can accurately self-administer insulin

confirmation that the patient is alert and able to make appropriate decisions about insulin doses

recording in the medical record of all insulin administered by both the patient and nurses

physician-written order that the patient may perform insulin self-management while hospitalised.
In addition, Dhatariya et al (2012) recommend the following:

Patients should be assessed as alert and competent at insulin delivery and blood glucose monitoring, ie, not affected by medication or acute illness.

Treatment requirements may differ from usual in the immediate post-operative period where there is a risk of glycaemic instability and clinical staff may need to make decisions about diabetes management.

The diabetes specialist team should be consulted if there is uncertainty about treatment selection or if the blood glucose targets are not achieved and maintained.

Guidelines should be in place to ensure that the ward staff know when to call for specialist help.

Involve the diabetes specialist team if blood glucose targets are not achieved and maintained.

Staff skilled in diabetes management should supervise surgical wards routinely and regularly.
Where there are disagreements between patients and ward staff in regards to the level of self-management, the diabetes inpatient specialist team should be available to support the decision (Joint British Diabetes Societies for Inpatient Care Group 2012).