Discharge Instructions for Diabetes Mellitus Type 2

Posted on 02/16/2018

Discharge Instructions for Diabetes Mellitus Type 2 

Diabetes mellitus is a condition characterized by elevated blood sugar (hyperglycemia) resulting from either the lack of insulin secretion, the body not being able to use the insulin it already has, or both. The long-term elevation in blood sugars that is a function of diabetes is connected to long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. The buildup of glucose (sugar) in the blood also means the body is not getting enough energy. 

Diabetes management involves controlling your blood glucose levels with good nutrition, exercise, and medications.

What You Will Need

  • Blood glucose meter (also known as a glucometer) and testing supplies
  • Medical alert identification 

Your doctor may want you to use insulin. If you do, you and your provider will decide the best way for you to take it. Some things you might need are:

  • Devices to deliver your insulin such as needle and syringes, insulin pen and needles, insulin pump and insertion sets
  • Alcohol swabs

Steps to Take for Home Care

If you are using insulin, you will need to check your blood glucose with a glucose meter. Your doctor/provider, diabetic educator, or pharmacist will teach you how to use it. Your specific goals may vary. In general, blood glucose levels should be:

  • Before meal or fasting blood glucose level should be in the range of 70-130 milligrams/deciliter (mg/dL)
  • After meal blood glucose level should be under 180 mg/dL

Hyperglycemia

You may not feel different when your blood glucose is elevated. This is why you may need to regularly check your blood glucose levels. However, you may experience symptoms of hyperglycemia, such as: 

  • More frequent urination
  • Increased thirst and appetite
  • Fatigue
  • Blurry vision
  • Numbness in feet 

If these symptoms occur, check your blood glucose level and call your doctor/provider or diabetes counselor. 

Hypoglycemia

It is not uncommon for people with diabetes to experience hypoglycemia, particularly when starting or adjusting to new medications. It is important that you know the symptoms of low blood glucose.

Some symptoms include shakiness, anxiety, hunger, increased heart rate, sweating, confusion, feeling faint, and headache. If you experience symptoms, follow the 15:15 rule:

First, check your blood glucose level using a glucose meter and strip. If the reading is less than 70 mg/dL or less than the number your doctor told you, do the following: 

  • Eat 15 grams of carbohydrate. This can be:
    • 4 ounces (118 milliliters) of fruit juice or regular soda
    • 2 tablespoons of raisins
    • 4 or 5 saltine crackers
    • 4 teaspoons of sugar
    • 1 tablespoon of honey or corn syrup
  • Wait 15 minutes.
  • Check your blood glucose level again. If it is still low, eat another 15 grams of carbohydrates. 

You may be given a prescription for a glucagon injection. If you cannot raise your blood glucose or if you pass out, you may need this injection. It is given like insulin. You may want to teach a family member how to give it to you. 

Diet

Following a healthy diet is important. You will need to evenly spread out the number of calories you eat and drink during the day. You may be referred to a dietitian. A dietitian can help you plan meals and snacks.

Follow these dietary guidelines: 

  • Eat a balanced diet. Ask your doctor or dietitian about the exchange diet and carbohydrate counting.
  • Avoid eating refined foods like white sugar, white flour, and white rice. Good carbohydrate sources include whole fruits, vegetable, whole grains, low-fat milk, and legumes.
  • Eat your meals and snacks at the same time every day.
  • Eat regularly. Do not skip meals.
  • Eat foods that are low in saturated fat and trans-fat and high in fiber.
  • Order diabetic meals on planes, at restaurants, or in hotels.
  • Limit the amount of alcohol you drink.
  • Keep a food diary. Share this with your doctor or dietitian.
  • As your weight changes or you become more active, talk to your doctor about your diet and medications. Your doctor may need to change your medications and dosages as you lose weight. 

Physical Activity

Exercise helps lower your blood glucose levels. Regular exercise can help keep your blood glucose in better control. Exercise increases insulin sensitivity and helps you lose weight. It can also help your overall health. Talk to your doctor before starting an exercise program.

Follow these physical activity guidelines: 

  • Aim for at least 150 minutes per week of moderate-intensity aerobic exercise
  • Try to do resistance training exercises at least 2 days per week
  • Wear comfortable, supportive, and protective footwear.
  • Monitor your blood glucose levels more often if you are exercising a lot. Be sure to check your levels before exercising.
  • Drink plenty of fluids before and during exercise.
  • To treat low blood glucose, have sugar pills or another source of sugar (like fruit juice) available when exercising. If you have symptoms of low blood glucose, stop exercising. Take sugar pills or fruit juice right away. 

Medications

Some people can control their type 2 diabetes with diet and exercise alone. Others need medication. Your doctor may prescribe medicine that: 

  • Causes cells in the pancreas to make more insulin
  • Enhances the action of insulin
  • Lowers the amount of sugar your intestines absorb
  • Lowers blood glucose levels through hormonal action other than insulin
  • Increases glucose excretion by the kidneys into the urine 

You might also need insulin shots. The type and amount you need depend on your blood glucose levels and the progression of your diabetes. Types of insulin include: 

  • Rapid-acting
  • Intermediate-acting
  • Long-acting
  • Premixed insulin such as combining fixed doses of rapid and intermediate-acting insulin 

If you are taking medications, follow these general guidelines: 

  • Take your medicines as directed.
  • Do not change the amount or the schedule.
  • Do not stop taking a prescription medication without talking to your doctor.
  • Do not share prescription medication.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicines and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out. 

Lifestyle Changes

Controlling diabetes is mostly about maintaining a healthy lifestyle. You and your doctor will plan changes that will help you, such as: 

  • If you are overweight, lose weight. Then, maintain a healthy weight.
  • Understand how stress can affect your blood glucose. Colds, the flu, or emotional stress can increase your blood glucose.
  • Wear a medical alert bracelet or necklace.
  • Take care of your feet. Keep them clean and dry. Always wear socks, slippers, or shoes.
  • If you smoke, talk to your doctor about ways to quit.
  • Talk to your doctor about vaccines to protect against pneumonia and the flu. 

Follow-up 

  • Have regular appointments with your doctor to monitor your progress and to look for any complications of diabetes
  • Have lab tests done regularly, such as:
    • HBGA1C – which measures an average of your blood glucose level over the last 2-3 months
    • Kidney function tests and urinalysis to check for signs of kidney disease
  • Meet with a dietitian.
  • Have your eyes examined at least annually to check for signs of diabetic retinopathy.
  • Have your feet examined at least annually to check for diabetic neuropathy. 

Call Your Doctor If Any of the Following Occurs

Diabetes can lead to many complications. Call your doctor if you have any of these symptoms: 

  • Blurry vision or flashing lights
  • Frequent infections
  • Wounds that do not heal
  • Chest pain
  • Trouble breathing
  • Erection problems
  • Blurry vision or new vision problems
  • Nausea or vomiting
  • Build-up of fluid or swelling in the legs
  • Pain, burning, or tingling sensations in the extremities
  • Change of color, odor, or temperature in feet
  • You have symptoms of hyperglycemia or hypoglycemia
  • Your blood glucose levels are out of range 

In case of an emergency, call for emergency medical services right away.