With newly diagnosed diabetes mellitus, hospitalization is indicated for the following conditions:
- Diabetic coma, pre-comatose state (intensive care and resuscitation department, in the absence of the latter – an endocrinological or therapeutic hospital of a multidisciplinary hospital, an endocrinological or therapeutic hospital of any hospital with round-the-clock laboratory monitoring of basic biochemical parameters).
- Severe decompensation of diabetes mellitus with or without ketosis or ketoacidosis (endocrinological hospital).
- Decompensation of diabetes mellitus, the need for the appointment and correction of insulin therapy (endocrinological hospital).
- Diabetes mellitus in any state of compensation in cases of allergies to various hypoglycemic agents, history of multivalent drug allergy (endocrinological hospital),
- Various degrees of decompensation of diabetes mellitus and the presence of a concomitant disease (pneumonia, exacerbation of cholecystitis, pancreatitis, etc.), possibly provoking a manifestation of diabetes, therapeutic hospital or another in the profile of the concomitant disease.
- Various degrees of decompensation of diabetes mellitus in the presence of pronounced manifestations of diabetic angiopathy – hemorrhage in the retina or vitreous humor, trophic ulcer or gangrene of the foot, myocardial infarction or other manifestations (hospitalization in the appropriate hospital).
Hospitalization of patients with newly diagnosed diabetes is not necessary with a satisfactory general condition of the patient, the absence of ketosis, relatively low levels of glycemia and glycosuria (11-12 mmol / l on an empty stomach and during the day), the absence of pronounced concomitant diseases and manifestations of various diabetic angiopathies, the possibility of achieving compensation without insulin therapy by prescribing a diet or diet in combination with oral hypoglycemic agents. The selection of glucose-lowering therapy on an outpatient basis has advantages over inpatient treatment, since it allows you to prescribe sugar-lowering drugs, taking into account the usual regimen for a patient daily. Outpatient treatment of such patients is possible with sufficient laboratory monitoring and examination of patients from all related specialists to assess the status of various vascular pools.
For hospitalization of patients with exacerbated diabetes mellitus, in addition to the medical examination plan, the following situations serve as:
- The development of diabetic and hypoglycemic coma, pre-comatose state (hospitals, as with newly diagnosed diabetes with a diabetic coma).
- Decompensation of diabetes mellitus, the phenomenon of ketoacidosis, the need for correction of insulin therapy, sulfanilamide therapy, the development of secondary sulfanilamide resistance. Patients with diabetes mellitus, especially of moderate severity, with ketosis without signs of ketoacidosis (satisfactory general condition, low levels of glycemia and daily glucosuria, daily urine response to acetone from traces to weakly positive), you can start measures to eliminate it on an outpatient basis. They are reduced to eliminating the cause of ketosis (to resume proper diet and the intake of hypoglycemic agents, cancel biguanides, etc.), recommendations to temporarily limit fats in the diet, expand fruits and natural juices, add alkalizing agents (alkaline drink, cleansing soda enemas). In patients receiving insulin, you can prescribe an additional injection of simple insulin from 6 to 12 units at the required time (day, evening) for 2-3 days. Often, these activities can eliminate ketosis within 1-2 days on an outpatient basis.
- Diabetes mellitus in any state of compensation and the progression of diabetic angiopathies of various localization and polyneuropathy (hospital of the corresponding profile – ophthalmologic, nephrological, surgical with the advice of an endocrinologist, endocrinological). Patients with severe diabetic angiopathies and especially retinopathies of the II-III stage, nephropathies with the phenomena of chronic renal failure of the II-III stage should be treated in hospitals 3-4 times a year and more often, according to indications. In the presence of decompensation of diabetes mellitus, it is advisable to correct the dose of sugar-lowering drugs in the endocrinology hospital, while the rest of the courses can be conducted in specialized departments.
- Diabetes mellitus in any condition of compensation and the need for surgical intervention (even with outpatient surgery; surgical hospital).
- Diabetes mellitus in any condition of compensation and the development or exacerbation of a concomitant disease (pneumonia, acute pancreatitis, cholecystitis, urolithiasis, etc.; hospital of the appropriate profile).
- Diabetes mellitus and pregnancy (endocrinological or obstetric department).