Blood sugars under control
November 26, 2012
New protocol shortens hospital stays for diabetic patients
Story and Photo by Colin Zak
About a quarter of all patients admitted to one of Calgary’s adult hospital has diabetes – and David Alexander is among them.
The 49-year-old has had diabetes for 40 years and knows first-hand the challenges diabetics can face controlling their blood sugar levels during a hospital stay.
“It can be tough to manage, especially for new diabetes patients. Every person is unique and faces a different set of challenges,” says Alexander, who has been in and out of hospital for everything from a stroke to an ear infection.
That’s why Alexander was happy to hear about basal bolus insulin treatment (BBIT), a new method for caring for hospitalized diabetics in Calgary, which allows clinicians to customize insulin regimens based on the unique needs of each patient.
Alberta Health Services introduced the system to inpatient units at Foothills Medical Centre, Rockyview General Hospital and Peter Lougheed Centre last year. A pilot study has shown that patients using BBIT had an average stay of 28.5 days in hospital, compared with 31 days for patients using the traditional, sliding scale insulin treatments.
“This has huge implications for improving people’s overall care while in hospital,” says Dr. Karmon Helmle, an endocrinology fellow at Richmond Road Diagnostic and Treatment Centre. “High blood sugars in hospital definitely contribute to a patient’s length of stay and can increase the rates of re-admission and mortality.”
Dr. Helmle developed BBIT along with Dr. Anthony Dechant, an internal medicine resident at University of Calgary, and Dr. Alun Edwards in Endocrinology Section of AHS-Calgary Zone.
BBIT allows clinicians to customize an insulin regimen for each patient, specially tailored to his/her weight, history with the diabetes, diet and how well he/she manages the disease. Organized in a computerized set of orders, clinicians administer insulin in a way that prevents blood sugar highs and lows from developing, so the patient feels much better.
Traditional sliding scale insulin treatment is not individualized and can result in greater blood sugar fluctuation throughout the day.
“We have spent countless hours educating physicians, nurses and other health care professionals about the protocol,” Helmle says. “It requires careful attention and monitoring so that the physician can make appropriate dose adjustments according to a patient’s needs.”
Helmle says the goal is to slowly phase out sliding scale insulin in Calgary, with the possibility of expanding the approach to all acute care sites in the province.