Navigating the Hospital with Type 1 Diabetes: What You Need to Know

By a Aimée José BSN RN CDCES

Setting Realistic Expectations

First, understand this: your blood glucose (BG) numbers will likely change.

This isn’t negative—it’s your body’s natural response to stress, illness, or surgery.

During times of acute illness or injury, stress hormones surge and can drive up BG levels.

The American Diabetes Association (ADA) provides guidelines for inpatient glucose control. According to the ADA:

•  ICU/Critically Ill Patients: BG target of 140–180 mg/dL (7.8–10.0 mmol/L)
•  Non-Critically Ill Patients: BG target of 100–180 mg/dL (5.6–10.0 mmol/L)

Hospital staff may not always specialize in T1D—many have more frequent experience with Type 2 diabetes. That’s okay.

You may know more about your diabetes than some of the staff, and that’s not a failure of care—it’s just reality.

Be prepared to take the lead where you can.

That said, the hospital’s top priority is your safety—and that includes avoiding hypoglycemia.

Hypoglycemia can be dangerous in a hospital setting, especially when you’re already unwell or under sedation. Hospital protocols are built around this priority, which may mean more conservative or unfamiliar approaches to insulin dosing.

Know this is not personal—it’s precautionary.

Ultimately, your care team wants to support your recovery and make sure your glucose is managed safely while your body focuses on healing.

More Info: Visit the ADA’s Diabetes Care in the Hospital resource: https://diabetes.org/tools-support/inpatient-diabetes-care

What is a Patient Advocate—and Why You Might Need One

A Patient Advocate is a member of the hospital staff who helps patients navigate their hospital stay, especially when questions or concerns arise about their care. They can:

• Resolve communication issues between patients and providers
• Clarify hospital policies or treatment plans
• Address concerns about your rights or care decisions
• Advocate on your behalf if you feel you’re not being heard

Tip: When you’re admitted, ask who the Patient Advocate is and how to reach them.

If you’re struggling to communicate your needs—or if your care doesn’t feel aligned with your diabetes management plan—they can be a helpful ally.

To learn more about the role of Patient Advocates and how they can support you, visit this CMS guide: https://www.cms.gov/medical-bill-rights/help/guides/patient-advocate

Planned Hospital Admissions

Whether you’re going in for surgery or another procedure, preparation is key.

Before Admission

• Identify who will be managing your diabetes care (ask questions until you feel confident).
• Bring a printed copy of your insulin regimen.
• Pack like you’re traveling:
  • All medications
  • CGM and pump supplies
  • Glucose tablets or low treatments
  • Your personal lancing device (hospital lancets are notoriously painful)
• Know which medications may impact BGs (e.g., steroids).
• Prepare to reduce insulin doses if fasting (15–25% reduction in basal is common).
• Consider switching to “Activity Mode” on AID systems

During Your Stay

• If alert and capable, you’re allowed to self-manage. Report your BGs and insulin doses to staff.
• If you’re not able to self-manage, hospital protocols will take over. Trust them—they’re evidence-based.
• Make sure your care team understands what diabetes devices you’re using (pump, CGM, AID system).
  • Clearly explain how they work, how to silence or acknowledge alarms, and what your plan is if something needs to be adjusted.
  • Consider placing a note at your bedside or in your chart with simple device instructions (e.g., “If alarm sounds, press center button and notify patient if awake.”).
• Advocate to keep your CGM and insulin pump on if safe to do so. You may need to temporarily remove them for imaging (like an MRI)—know where and when you can reconnect.
• Communicate openly with your RN or admitting nurse about your typical diabetes routine and how you’d like to participate in your care.

Discharge Planning

• Double-check that you leave with everything you brought.
• Understand any new medications or changes in insulin dosages.
• Schedule follow-up with your endocrinologist within 1–2 weeks.
• Ask what to expect from your BG patterns post-discharge.

Unplanned Hospital Visits

• If possible, have a support person who understands your diabetes be with you.
• Resume self-management of your diabetes as soon as you’re able.
• If you’re on an insulin drip, ensure your long-acting insulin is given 2 hours before stopping the drip to avoid lapses.

Patient Rights and Advocacy

• If you’re awake and alert, you have the final say in your medical care.
• Don’t be afraid to speak up if something doesn’t feel right.
• Negotiation with your care team is part of good advocacy.
• If you’re unable to make decisions, trust that hospital protocols are designed for safety and based on solid evidence.

Quick Cheat Sheets for Managing T1D in the Hospital

Hospital Packing Checklist

• Insulin pens/pump + backup syringes
• All CGM and pump supplies
• Glucose meter + personal lancing device
• Fast-acting sugar (glucose tabs, juice, etc.)
• Paper copy of insulin regimen and/or pump settings
• Contact info for your endocrinologist
• Written note explaining how your devices work
• Medical alert ID
• List of medications

Hospital Self-Management Checklist

• Inform staff you have T1D (not T2D)
• Keep CGM and pump on if allowed
• Tell staff how to operate your devices
• Carry and use your own low treatments—inform RN
• Track and report your own BGs and insulin doses
• Ask if any medications could impact BG
• Adjust basal insulin if fasting (decrease 15–25%)
• Request to keep your own supplies at bedside
• Know the name of your hospital’s Patient Advocate

Discharge Checklist

• Reconcile medications—leave with everything you brought
• Understand changes in insulin or new meds
• Know what to expect in post-discharge BG patterns
• Book follow-up with your endo in 1–2 weeks
• Resume your full at-home diabetes management routine

Final Thoughts

Managing T1D in the hospital can be challenging, but being prepared, informed, and assertive can make all the difference. Don’t hesitate to ask questions, advocate for yourself, and lean on hospital resources like the Patient Advocate. Your health, your voice, and your expertise in your own body matter—especially in the hospital setting.