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:

• 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 patient the “Rule of 15”: commonly used as a guideline for 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
• Wait 15 minutes
• Check blood glucose again
• Consume an additional 15 g carbohydrate if blood glucose is still below 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

Meal Planning
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
• Do not skip meals; eat meals and snacks at the same time each day

“Create Your Plate” 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 the largest section with non-starchy vegetables
  • Add grains and starchy food (whole grains, etc.) in one of the small sections
  • Add protein in the other small section
• Add a serving of fruit and/or dairy

“Carbohydrate Counting” is a technique that tracks carbohydrate intake to keep blood glucose in the target range. Tools are available to assist with counting carbohydrates, such as SuperTracker (https://www.supertracker.usda.gov). This is particularly helpful to track whole foods, fruits, grains, and vegetables without nutritional labels.

• Start with 45-60 grams of carbohydrate at a meal
  • More or fewer may be needed depending on activity and management of diabetes
• Foods that contain carbohydrates are:
  • Grains: rice, oatmeal, and barley
  • Grain-based foods: bread, cereal, pasta and crackers
  • Starchy vegetables like potatoes, peas and corn
  • Fruit and juice
  • Milk and yogurt
  • Dried beans, like pinto beans, and soy products, like veggie burgers
  • Sweets and snack foods like sodas, juice drinks, cake, cookies, candy and chips