Lippincott Nursing Pocket Card - Updated Oct. 2021

Discharge Planning for Patients with Diabetes Mellitus

For patients with diabetes mellitus, patient education at discharge is important to reduce complications and readmissions. Ensure the tasks below are completed before discharge of patients with diabetes mellitus (American Diabetes Association, 2018):

Medication reconciliation
Structured discharge communication
Education on diabetes self-management:
- Identify the health care provider who will provide diabetes care after discharge.
- Assess the patient’s level of understanding related to the diagnosis of diabetes, self-monitoring of blood glucose (SMBG), and home blood glucose goals.
- Teach the patient the definition, signs and symptoms, treatment, and prevention of hyperglycemia and hypoglycemia.
- Provide information on consistent eating patterns.
- Tell the patient when and how to take blood glucose-lowering medications, including method of administration.
- Instruct the patient on specific measures for managing diabetes on sick days.
- Educate the patient on proper use and disposal of needles and syringes.
Provide appropriate durable medical equipment, medication, supplies and prescriptions, as appropriate, including:
- Insulin (vials or pens)
- Syringes or pen needles
- Oral medications
- Blood glucose meter and strips
- Lancets and lancing devices
- Urine ketone strips
- Glucagon emergency kit
- Medical alert application/charm
Tell the patient about these survival skills:
- Know how to recognize, treat, and prevent hyperglycemia and hypoglycemia
- Learn how to perform SMBG
- Check blood glucose before driving
- Know how to take or administer prescription medications
- Know the importance of meal planning (see below)
- Keep an easy-to-reach snack or fast-acting sugars handy always
- Know how to manage diabetes when sick
- Wear a medical ID tag or bracelet
- Contact a health care provider if hypoglycemia occurs more than twice a week
- Remember the importance of following up with a health care provider regularly
Referral to an outpatient diabetes center for follow-up education by a certified diabetes educator

Teach the “15-15 Rule” commonly used as a guideline for hypoglycemia treatment

Check glucose level with meter to determine if blood glucose is below 70 mg/dL.
Eat or drink 15 g of simple, concentrated carbohydrates. Examples include:
- Glucose tablets (follow instructions)
- Gel tube (follow instructions)
- 4 ounces (1/2 cup juice or regular soda)
- 1 tablespoon of sugar, honey, or corn syrup
- Hard candies, jellybeans, or gumdrops (check label)
Wait 15 minutes.
Check blood glucose again.
Consume an additional 15 g carbohydrate if blood glucose is still below 70 mg/dL.
Repeat these steps until your blood sugar is at least 70 mg/dL.
Follow up with a light snack or meal once glucose is stable.
Mild to moderate hypoglycemia can usually be reversed rapidly (within 5-10 minutes).
Avoid foods high in fat because they slow the absorption of carbohydrates.
Remind your patient to make a note about episodes of hypoglycemia and to discuss with their health care provider why it happened and ways to prevent it.

Treating Severe Hypoglycemia (American Diabetes Association, 2021a)

Educate the patient and family members on how to respond to severe hypoglycemia.
- If low blood sugar is not treated promptly and the patient requires assistance to recover, glucagon may be needed.
- Glucagon is available by prescription as an injectable or inhalable.
- Call 911 immediately if the patient becomes unconscious and glucagon is not available, or someone does not know how to use it.
- Do NOT inject insulin as this will lower the person’s blood sugar more.
- Do NOT give food or fluids as the patient may choke.

Meal Planning (American Diabetes Association, 2021b)

General guidelines:

Make a plate colorful with fruit, vegetables, whole grains, beans, nuts, and lean protein.
Watch calories.
Eat foods high in fiber, low in fat, and with a low glycemic index.
Select foods that are unprocessed and rich in nutrients
Do not skip meals; eat meals and snacks at the same time each day.

“Diabetes Plate Method” (American Diabetes Association, 2020) is a strategy to change portion size to larger amounts of non-starchy vegetables and smaller portions of starchy foods.

Draw a line down the middle of the plate. Then, on one side, cut in half again, giving you a total of three sections.
- Fill 1/2 the plate with non-starchy vegetables.
- Add carbohydrates (whole grains and starchy vegetables) to fill 1/4 the plate.
- Add lean protein to the last 1/4 section of the plate.
Choose water or a low-calorie drink.

“Carbohydrate Counting” (ADA, 2021b) is a technique that tracks carbohydrate intake to keep blood glucose in the target range. Tools are available to assist with counting carbohydrates. These are particularly helpful to track whole foods, fruits, grains, and vegetables without nutritional labels.

If the patient takes mealtime insulin, carbohydrates should be counted, and insulin is dosed based on that count. This is recommended for people on intensive insulin therapy by shots or pump (people with type 1 and some type 2 diabetes).
People with type 2 diabetes who don’t take mealtime insulin may use the Diabetes Plate Method (above) or “carbohydrate choices,” where one “choice” contains about 15 grams of carbohydrate.
The number of carbohydrates each person needs is based on body size, activity level, appetite, and hunger. Encourage patients to develop a medical nutrition therapy with a registered dietician.

Examples of foods with 15 grams carbohydrate

1 small piece fresh fruit (4 oz)	4-6 crackers	1/2 cup icecream or sherbert
½ cup canned or frozen fruit	½ English muffin	2-inch square brownie
1 slice bread (1 oz)	½ hamburger bun	2-inch square cake, no frosting
1 (6 inch) tortilla	¼ large baked potato (3 oz)	1 Tbsp syrup, jam, jelly, honey
½ cup oatmeal	2/3 cup plain fat free yogurt	6 chicken nuggets
1/3 cup pasta or rice	2 small cookies	½ cup casserole
½ cup black beans	1 cup soup

References:

American Diabetes Association. (2018). Standards of Medical Care in Diabetes–2018. Diabetes Care: The Journal of Clinical and Applied Research and Education, 41(1), S1-S151.

American Diabetes Association. (2020, February). What is the diabetic plate method? https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html

American Diabetes Association (2021a). Hypoglycemia (Low Blood Sugar). https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

American Diabetes Association. (2021b). Carb counting and diabetes. https://www.diabetes.org/healthy-living/recipes-nutrition/understanding-carbs/carb-counting-and-diabetes

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Discharge Planning for Patients with Diabetes Mellitus