Discharge Planning

Prior to discharge, the patient’s outpatient diabetes medication regimen should be carefully reviewed and reconciled. Adjustments are often needed, guided by the clinical presentation and an understanding of what precipitated the hyperglycemic crisis.

Comprehensive diabetes education should be provided, including instruction on:

• Blood glucose monitoring and use of logbook
• Proper insulin injection technique, timing, and dose adjustment
• Recognition, treatment, and prevention of hypoglycemia
• Nutrition education and meal planning
• Sick day management and medication adjustment during illness
• When to seek medical attention
• Importance of medication adherence

Follow-up within 1 week of discharge is essential and should include laboratory testing to assess glycemic control. Referral to an endocrinologist is appropriate if the patient does not already have specialty care established.

Providing patients with an emergency glucagon kit, ketone test strips, and clear sick day management instructions can help prevent future episodes of DKA or HHS.

Exploring social determinants of health and barriers to care is key, as socioeconomic factors often contribute to hyperglycemic crises risk. Access to medications, supplies, medical nutrition therapy, and outpatient resources should be addressed.

Lifestyle factors including alcohol and substance use should also be reviewed. Smoking cessation counseling is appropriate given increased risk of complications in those who smoke.