How can we make diabetes care safer from hospital to home?

Lance Alexander (0:01)

Best of Live Well ft. Lance Alexander.

Lance Alexander (0:05)

Let's talk about diabetes and diabetic care involving more than bringing high blood sugar down. It also means preventing it from falling too low, spotting problems early and making sure patients know how to manage their treatment when they leave the hospital.

Diabetes damages blood vessels and nerves throughout the body. That same damage affects the heart, kidneys, and circulation, making heart and kidney disease much more likely. At the National University Hospital, newer treatments are being used to help protect the heart and kidneys. Doctors and nurses are combining earlier monitoring with faster emergency treatment and support after discharge to help patients receive care safely. So what does safer diabetes care look like? And what should patients and their families know? With us is Dr. Doddabele Srinivasa Deepak, Senior Consultant, Division of Endocrinology at the National University Hospital, as well as Heng Boon Ling, Advanced Practice Nurse at the National University Hospital. Welcome to the show, the two of you.

Dr Doddabele Srinivasa Deepak (1:19)

Good morning, Lance.

Lance Alexander (1:20)

Good morning.

Dr Doddabele Srinivasa Deepak (1:20)

Good morning to your listeners too.

Lance Alexander (1:21)

Hi, good morning, Lance and to all listeners, good morning.

Lance Alexander (1:25)

Good morning. Dr. Deepak, let's start with you. Tell us more about these new inpatient treatments at NUH that offer benefits beyond blood sugar control.

Dr Doddabele Srinivasa Deepak (1:34)

Yes. Thank you. So we start off with the concept that patients with diabetes, diabetes as you know is very prevalent in Singapore, but equally in a large tertiary hospital like NUH, almost 40 to 50 percent of patients who are admitted at any time will have diabetes. So it may not be that they came in because of their diabetes problem, but in whatever problem they came in with, they sure will have diabetes in up to 40 to 50 percent of patients. Therefore it's important for us to understand the figure, the population that we are seeing every day, and more importantly make sure that their journey throughout the hospital stay is safe, both in respect to whatever condition they came in for, but more importantly to ensure that their diabetes is well managed. And the reason for this is very simple.

Studies have shown extensively and all over the world that having high blood sugars, hyperglycemia, as we call it in technical terms, is actually a detrimental factor for the patient's stay in hospital. In other words, those patients who have high blood sugars in hospital do suffer from longer lengths of stay, infection complications, other complications related to, say, a surgery that they have been admitted for, and eventually, in some unfortunate instances, they can also die because of complications from diabetes. So not only is it stressful for the family and for the patient, of course, but having surgery, infection or illness puts an additional stress on the body, and that makes hyperglycemia, which is high levels of glucose, quite a common feature for patients in hospital.

Lance Alexander (3:13)

Boon Ling, you're a nurse and you handle a lot of patients in the ward. What changes are nurses on the lookout for, and when should they be calling out for specialist help?

Lance Alexander (3:29)

Yeah, so for nurses in the ward, they are always on the move, and what happened is that they are always 24-7 with the patient. So what we have in our system is that we recognize risk, but nurses are the ones that actually provide timely rescue. So they are there to provide timely rescue and save recovery of patients. So the rapid and timely intervention of nurses in the ward are critical to patients in the ward.

Lance Alexander (3:57)

Okay, maybe you can tell us as well, what are some of the signs that you can notice straight away and say we need to react?

Lance Alexander (4:03)

Sure. So what happened here is that in the hospital, we have a nurse lab project. We have this project called the hypoglycemia box.

And why this hypoglycemia box is started is because nurses, we frequently see patients in the ward having hypoglycemia. And what started this hypoglycemia box project is that nurses, when they recognize patients having hypoglycemia, and they have to rescue the patient. And when they have to rescue the patient with the necessary item, they have to go around to different locations of the ward to pick up the different items required. Like for example, the gastro powder, the carbs, the stirrer, and then the tummer. And so, they have to bring all this to together at a different location. And this makes things a little bit difficult, and timely rescue is important, and we want to rescue patients fast without any delay.