Managing Diabetes: Should My Father Be Hospitalized or Treated at Home?

Diabetes issues

My father, 46 years old, male, has no family history of diabetes.
He was recently diagnosed with diabetes and diabetic ketoacidosis (DKA) after a hospital visit where his blood glucose level was measured at 486 mg/dl.
Due to a lack of available beds in the hospital's metabolic department, he was given medication and insulin, and a diabetes educator provided dietary control guidance before he returned home to rest.
He is currently taking oral hypoglycemic agents: Diamicron MR 30 mg and Glucophage 500 mg, to be taken after breakfast and dinner.
Additionally, he injects Lantus insulin at a dose of 16 units every night before bed.
His blood glucose levels are as follows: fasting blood glucose at 293 mg/dl, postprandial blood glucose at 316 mg/dl, and bedtime blood glucose at 298 mg/dl.
Should he be hospitalized for better insulin management, or can he manage at home with dietary control and medication adherence, returning for a follow-up in a week?

Chen Pangpang, 10~19 year old female. Ask Date: 2017/08/14

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Chen,
Diabetic ketoacidosis (DKA) is classified as a hyperglycemic emergency.
Key diagnostic points include hyperglycemia, the presence of ketones in urine or blood, and a significant acidotic blood pH.
The symptoms can vary widely and may include dehydration, abdominal pain, fatigue, and potentially fever, infection, or coma.
Common precipitating factors for DKA include poor blood glucose control, cessation of insulin therapy, infections, strokes, excessive stress, certain medications, and surgical procedures.

Therefore, in addition to controlling blood glucose levels, it is essential to address the underlying precipitating factors for effective treatment.
Your father has received care from a metabolic specialist and a health educator, and based on subsequent blood glucose responses, he should experience a positive treatment outcome.

Regarding the question of hospitalization, it depends on the severity of the condition and associated factors.
Some patients may require admission to an intensive care unit, others to a general ward, while some may only need outpatient treatment; this is determined by clinical changes and the physician's judgment.

Insulin therapy or oral medication treatment must be guided by clinical presentation and response; the physician will consider various factors before making a decision.
Since your father was newly diagnosed with diabetes and presented with DKA, initiating insulin therapy is a very reasonable and prudent approach.
Whether he will need to continue insulin injections in the future will depend on his response to treatment.
It seems that your attending physician is very experienced and decisive, and I encourage you and your father to have a thorough discussion with him.
However, regardless of the treatment plan, dietary control, regular exercise, weight management, and lifestyle adjustments remain critically important.

Reply Date: 2017/08/14

More Info

Managing diabetes, especially in the context of diabetic ketoacidosis (DKA), is a critical issue that requires careful consideration of the patient's condition and the potential risks involved. Your father's recent diagnosis of diabetes and the occurrence of DKA, indicated by a blood glucose level of 486 mg/dl, suggests that he is in a precarious situation. DKA is a serious complication of diabetes that can lead to severe dehydration, electrolyte imbalances, and even coma if not treated promptly and effectively.

Given that your father has been discharged from the hospital after receiving initial treatment, it is essential to assess whether he should continue his care at home or be readmitted for further treatment. The medications prescribed, including Diamicron MR and Glucophage, along with the nightly insulin injection of Lantus, are standard treatments for managing blood glucose levels. However, the current blood glucose readings you provided—293 mg/dl before meals, 316 mg/dl after meals, and 298 mg/dl at bedtime—indicate that his blood sugar levels remain elevated.

In general, the decision to manage diabetes at home versus hospitalization depends on several factors:
1. Severity of Symptoms: If your father is experiencing symptoms such as excessive thirst, frequent urination, fatigue, nausea, or abdominal pain, these could indicate that his diabetes is not well-controlled and may warrant hospitalization.

2. Blood Glucose Levels: Consistently high blood glucose levels, especially those exceeding 300 mg/dl, are concerning. If his levels do not improve with the current treatment regimen, it may be necessary to consider hospitalization for closer monitoring and adjustment of his insulin therapy.

3. Risk of DKA Recurrence: Since your father has already experienced DKA, he is at a higher risk for recurrence. If he shows any signs of DKA, such as fruity-smelling breath, confusion, or rapid breathing, immediate medical attention is required.

4. Support at Home: Assess whether you and your family can provide the necessary support for managing his diabetes at home. This includes monitoring blood glucose levels regularly, administering insulin, and ensuring adherence to dietary recommendations.

5. Follow-Up Care: If you decide to manage his condition at home, it is crucial to have a follow-up appointment scheduled within a week to reassess his blood glucose levels and overall health. Regular communication with his healthcare provider is essential to adjust medications as needed.

In conclusion, while some patients can manage their diabetes at home with proper education and support, your father's current situation, including his recent DKA episode and ongoing elevated blood glucose levels, suggests that he may benefit from hospitalization for more intensive management. This would allow healthcare professionals to monitor his condition closely, adjust his treatment plan, and provide education on managing diabetes effectively. Ultimately, the decision should be made in consultation with his healthcare provider, who can assess his specific circumstances and provide tailored recommendations.

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