Discharge planning for hospitalised adults using insulin

Discharge management of hospitalised adults with hyperglycaemia or diabetes should be planned well in advance (at least a few days).

For adults with diabetes who had insulin substituted for their usual noninsulin antihyperglycaemic drugs while in hospital, those drugs should be restarted (if appropriate) a few days before discharge, either with or without stopping the insulin.

For adults started on insulin for hyperglycaemia while in hospital, consider whether to continue insulin when they are discharged. Take into account the patient’s preadmission glycaemic profile, current blood glucose concentrations and other comorbidities. If insulin is to be continued, early engagement of the patient with a multidisciplinary diabetes team is needed to teach the patient to self-monitor blood glucose concentrations and assess carbohydrate intake to guide insulin dosage. Education should also include sick-day and other diabetes self-management.

For continuity of care, it is essential that decisions about ongoing management are communicated to the patient’s regular general practitioner and multidisciplinary diabetes team (if applicable). Immediately after discharge, patients are likely to need adjustment of insulin doses; concurrent treatment changes can necessitate corresponding changes to insulin doses, for example a weaning course of glucocorticoids (see Glucocorticoid-induced hyperglycaemia).

Hospitalised adults with newly diagnosed hyperglycaemia need to have definitive testing for diabetes after discharge (see Tests to diagnose diabetes).