{"id":16236,"date":"2018-06-04T10:44:47","date_gmt":"2018-06-04T16:44:47","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=16236"},"modified":"2021-09-07T17:12:42","modified_gmt":"2021-09-07T23:12:42","slug":"glucose-management-team-as-important-as-ever-to-inpatients","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/glucose-management-team-as-important-as-ever-to-inpatients\/","title":{"rendered":"Ten years on, Glucose Management Team as important as ever to inpatients"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_16237\" aria-describedby=\"caption-attachment-16237\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-16237\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family.webp\" alt=\"Chloe Johnson and husband Tom keep busy with grandkids (left to right) Lucy, Eden, Eliana, Eleanor and Kayden.\" width=\"300\" height=\"271\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family.webp 1109w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family-300x271.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family-1024x923.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family-768x693.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family-150x135.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043821\/EXT_05XX18-ChloeJohnson_Family-200x180.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-16237\" class=\"wp-caption-text\">Chloe Johnson and husband Tom keep busy with grandkids (left to right) Lucy, Eden, Eliana, Eleanor and Kayden.<\/figcaption><\/figure>\n<p>Chloe Johnson has type 1 diabetes. Since 2004, the retired middle-school English teacher and grandmother of five has had an insulin pump. Generally, she no more needs help using it to control her blood sugar than she would need help diagramming this sentence.<\/p>\n<p>\u201cI can take care of myself a whole lot better than anybody else,\u201d she said, \u201cas long as I\u2019m conscious.\u201d<\/p>\n<p>That caveat is among the many reasons that <a href=\"https:\/\/www.uchealth.org\/provider\/mike-mcdermott-md-endocrinology-diabetes-and-metabolism\/\">Dr. Michael McDermott<\/a> launched the inpatient Diabetes Management Program at UCHealth University of Colorado Hospital (UCH) in 2004 and, in 2008, formed the program\u2019s Glucose Management Team, one of the few such inpatient services in the country.<\/p>\n<p>Johnson, 65, has had health problems that have led to hospital stays, including a 2013 kidney transplant. During those stays, she hasn\u2019t always been fully conscious. That\u2019s when the hospital\u2019s Glucose Management Team steps in.<\/p>\n<p>\u201cIt\u2019s really helpful because a lot of times, you can\u2019t think straight because you\u2019re just whacked out with what\u2019s going on,\u201d Johnson said. \u201cThey take the pump out of your hands and I feel totally safe.\u201d<\/p>\n<h3>Management challenge<\/h3>\n<p>Proper diabetes management is painstaking for an individual such as Johnson even during the normal course of her life. She has to take into account what she eats, physical activity, how she feels, and the readings from finger-poke blood tests throughout the day, among other factors. An inpatient hospital environment introduces even more complexity.<\/p>\n<p>Being sick can increase the production of growth hormone, cortisol and adrenaline, which can boost blood sugar \u2013 it\u2019s called stress hyperglycemia, and it can make non-diabetics temporarily diabetic and thrust diabetics out of control. Medications can also affect blood-sugar levels, as can skipped meals in advance of scans or surgical procedures or the changes in diet and exercise parcel to hospital stays. It\u2019s not uncommon, either, for patients to find out they have diabetes after being admitted for entirely different reasons. The Glucose Management Team steps in then, too.<\/p>\n<p>Underlying all this is that the consequences of diabetes can be grave for hospital inpatients. High blood sugar increases a patient\u2019s risk for hospital-acquired pneumonia, heart failure and infection as well as complications following surgery (orthopedic surgeons, for example, will often insist that patients coming in for non-emergency procedures such as knee replacements have their blood glucose under control).<\/p>\n<p>\u201cDiabetes just causes bad outcomes,\u201d summed up McDermott.<\/p>\n<h3>One in four<\/h3>\n<p>McDermott launched the inpatient Diabetes Management Program to establish best-practice standards of care and to teach nurses and doctors on how to manage diabetes patients. Before long, though, it was clear that it would take much more.<\/p>\n<figure id=\"attachment_16238\" aria-describedby=\"caption-attachment-16238\" style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-16238\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam.webp\" alt=\"Picture of UCHealth's Glucose Management Team.\" width=\"300\" height=\"214\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam.webp 1200w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam-300x214.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam-1024x731.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam-768x548.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam-150x107.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2018\/06\/04043825\/EXT_05XX18-UCH_InpatientDiabetesTeam-200x143.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-16238\" class=\"wp-caption-text\">The University of Colorado Hospital Inpatient Diabetes Program has set the course for diabetes care across UCHealth. At UCH, the program\u2019s Glucose Management Team works directly with patients to keep their blood sugar under control. From left, Kim Vigliotta, a nurse and diabetes educator; UCH Diabetes Program Director Dr. Michael McDermott; Dr. Cecilia Low Wang, director of the UCH Glucose Management Team; nurse and Diabetes Program Manager Elaina Thompson; and nurse\/diabetes educator Bridget Everhart.<\/figcaption><\/figure>\n<p>More than one quarter of patients admitted to UCH have diabetes. As noted, managing it can be tricky, requiring not only knowledge and expertise, but also enough experience with diabetes care (as well as an evolving bevy of technologies including closed-loop systems, continuous pumps and different types and concentrations of insulin) to recognize and adjust to nuances that can, without action, turn into a diabetic crisis. Ten years ago this September, the Glucose Management Team took shape with a physician, a clinical nurse specialist and a physician assistant. Ten years hence, the team has grown to eight clinical nurse specialists, physician assistants and nurse practitioners led by UCHealth endocrinologist and diabetes specialist <a href=\"https:\/\/www.uchealth.org\/provider\/cecilia-low-wang-md-endocrinology-diabetes-and-metabolism\/\">Dr. Cecilia Low Wang<\/a>. They see about 40 patients a day, focusing on the trickiest cases. Team members see patients seven days a week and are on call 24\/7.<\/p>\n<p>Nurse Practitioner Stacy Seggelke has been with the Glucose Management Team since the beginning. She\u2019s kept an eye on Chloe Johnson during inpatient stays since just after the 2013 kidney transplant, when Johnson wasn\u2019t entirely conscious. Given the medications and the various other factors affecting Johnson\u2019s blood sugar, Seggelke took care of Johnson\u2019s pump.<\/p>\n<p>\u201cShe came in and explained to me how she was changing the settings. She was just fabulous,\u201d Johnson said.<\/p>\n<p>Seggelke looks beyond blood sugar, Johnson added. One example: Seggelke suggested grief counseling after the death of Johnson\u2019s son, the father of three of Johnson\u2019s grandchildren, which turned out to be an enormous help. Another example: Johnson had taken a fall the day before a diabetes check and landed hard on her wrist. Seggelke didn\u2019t like the look of it and sent her down to the UCH Emergency Department, where indeed it was diagnosed as broken.<\/p>\n<p>\u201cShe just seems to really want to help the whole person, and she totally understands that your diabetes affects the whole person,\u201d Johnson said.<\/p>\n<h3>Epic scope<\/h3>\n<p>The team\u2019s work extends into patient and provider education, adds Low Wang. \u201cThere\u2019s diabetes-related stress among those who have a known diagnosis and are feeling out of control,\u201d she said. \u201cAnd if you\u2019ve never had diabetes and you come in and become hyperglycemic, there are tons of questions on what the implications are.\u201d<\/p>\n<p>The Diabetes Management Program has a similarly expansive view of its duties. Its standards are now codified into UCHealth\u2019s Epic electronic health record, and many have become the baseline for inpatient diabetes care across all UCHealth hospitals, said Elaina Thompson, the program\u2019s nurse manager.<\/p>\n<p>The program has continued to evolve, Thompson said, in part by harnessing the electronic health record. The technology enables remote tracking patients\u2019 blood glucose and, if something seems off, reaching out to physicians and nurses to offer advice or assistance to help get the patient back on track. They\u2019ve also created a formal knowledge assessment \u2013 a sort of quiz \u2013 to establish a patient\u2019s sophistication with respect to managing their diabetes before approaching them with additional education. You don\u2019t want to belabor the basics with the likes of Chloe Johnson, after all.<\/p>\n<p>\u201cThe motto is \u2018teach to their needs,\u2019\u201d Thompson said. \u201cIf I\u2019m a patient and you\u2019re telling me stuff I already know, chances are you\u2019ve tuned me out by the time we get to the stuff I don\u2019t know.\u201d<\/p>\n<p>The work has paid off not just for patients, but also in terms of national recognition. The Society of Hospital Medicine has ranked UCH among the country\u2019s top performers in controlling its inpatients\u2019 blood sugar, and the Diabetes Management Program has become one of the fewer than 2 percent of U.S. hospitals to receive Joint Commission <a href=\"https:\/\/www.jointcommission.org\/certification\/inpatient_diabetes.aspx\">certification<\/a> for advanced inpatient diabetes care. It\u2019s the only such hospital in Colorado.<\/p>\n<p>It\u2019s about much more than bragging rights, though.<\/p>\n<p>\u201cNo matter what you\u2019re in the hospital for, if you\u2019re diabetic, it\u2019s going to play a part in your treatment and can have an impact on how they treat you, how they should teat you, and what they need to be aware of and take care of,\u201d Johnson said.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Chloe Johnson has type 1 diabetes. Since 2004, the retired middle-school English teacher and grandmother of five has had an insulin pump. Generally, she no more needs help using it to control her blood sugar than she would need help diagramming this sentence. \u201cI can take care of myself a whole lot better than anybody [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":16237,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[988,2635,342],"class_list":["post-16236","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-diabetes-endocrinology-care","tag-diabetes-management","tag-endocrinology"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Ten years on, Glucose Management Team as important as ever to inpatients - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The University of Colorado Hospital Inpatient Diabetes Program has set the course for diabetes care across UCHealth. 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