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# Diabetes self-management teaching before discharge: monitoring, food, activity and sick-day rules

- Safe practice

Before discharge the patient and family learn their medicines, glucose checks, lows, food, activity and what to do on sick days.

Updated Nov 13, 2026

## Key points

- Survival skills before discharge: medicines and device, glucose checks, lows and highs, sick days, supplies and follow-up.
- Sick days: keep taking insulin and the other medicines unless the care team says otherwise, check glucose about every 4 hours and check ketones.
- Go to the emergency department: trouble breathing, ketones, unable to keep liquids down for more than 4 hours, or vomiting or diarrhoea for more than 6 hours.
- Activity: moderate aerobic exercise at least 150 minutes a week; check glucose before and after; avoid intense exercise when fasting or with low glucose.
- Good control (MinSalud guideline): HbA1c at or below 7 %; a yearly eye exam, and kidney and foot checks.
- Follow-up within a month, or within 1–2 weeks if medicines changed; after DKA, within 2–4 weeks.

## What it is

Discharge teaching gives the person with diabetes and the family the skills to stay safe at home. It covers how to take and inject the medicines with the device used at home, glucose monitoring, recognising and treating lows and highs, food, physical activity, sick-day rules, and the use and disposal of supplies. Medicine reconciliation and a follow-up appointment are part of the plan. In Colombia, the Ministry's guideline for adults with type 2 diabetes stresses a healthy lifestyle (regular meals, activity, no smoking) and good control, judged by HbA1c. The nurse also screens for barriers that cause readmissions: low mood, eating problems, cost of insulin and food or housing insecurity.

## What it requires

- Teaching uses the device the person will use at home (pen, syringe, meter).
- Family members know the signs of a low, what to give, when to call for help and how to give glucagon if it is prescribed.
- Sick-day kit: medicines and supplies for several weeks, a thermometer, ketone strips and easy foods and drinks.
- There is no cure for diabetes, but food, activity and medicines keep it under control.

## How it is applied (and why)

- Assess what the person already knows and whether vision or dexterity limit self-care: teaching starts from their needs.
- Teach the injection and the glucose check with the device used at home, and ask the person to show you: it confirms the skill.
- Teach the signs of a low and how to treat it, and when to call for help: lows are the most frequent emergency at home.
- Teach sick-day rules: keep the medicines, check glucose every 4 hours, check ketones, drink fluids and try to eat.
- Explain the warning signs that need the emergency department: ketones, breathing difficulty, vomiting or confusion.
- Review food with regular meal times and activity with glucose checks before and after: both lower glucose.
- Teach daily foot inspection and the eye, kidney and foot checks: they detect complications early.
- Reconcile the medicines, confirm supplies and book the follow-up: gaps in supplies cause readmissions.
- Ask about mood, eating problems, costs and support at home and refer as needed: they are causes of DKA and readmission.

## In nursing practice

- Continuous glucose monitoring after discharge may reduce admissions for DKA in some patients.
- Diabetes self-management education and support programmes continue the teaching after discharge.
- A fever or unplanned weight loss during an illness can be a sign of infection or high glucose.
- Ask the care team how to adjust insulin for food, activity and illness: the plan is individual.

## Common mistakes

- Telling the patient to stop insulin when they cannot eat: insulin needs may change, but the decision belongs to the care team.
- Teaching with a different device from the one the person will use at home.
- Discharging without supplies, without a follow-up date or without telling the family about lows.
- Not asking about cost, food or mood, which are frequent causes of missed doses.

## Test yourself

Think of the answer, then tap the question to see it.

## What should a person with diabetes do with insulin on a sick day?

Keep taking insulin and the other medicines unless the care team says otherwise, check glucose about every 4 hours, check ketones and call if they are present.

## What are three reasons to go to the emergency department on a sick day?

Trouble breathing, ketones in the urine, being unable to keep liquids down for more than 4 hours, or vomiting or severe diarrhoea for more than 6 hours.

## What physical activity does the Colombian guideline recommend for adults with type 2 diabetes?

Moderate aerobic exercise such as walking, cycling, swimming or dancing, at least 150 minutes a week, checking glucose before and after.

## What does «survival skills» teaching include before discharge?

Taking and injecting the medicines, glucose monitoring, recognising and treating lows and highs, sick-day rules, use and disposal of supplies, and the follow-up appointment.

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## Connections

## Related 5

- [Patient education and teach-back](https://durgical.com/en/nursing/patient-education-and-teach-back/)
- [Nursing follow-up in chronic-disease programmes: hypertension and diabetes in primary care](https://durgical.com/en/nursing/nursing-follow-up-in-chronic-disease-programmes-hypertension-and-diabetes-in-pri/)
- [The diabetic foot: daily inspection, risk screening and foot-care teaching](https://durgical.com/en/nursing/the-diabetic-foot-daily-inspection-risk-screening-and-foot-care-teaching/)
- [Hypoglycaemia: recognising it and the nursing response, conscious and unconscious](https://durgical.com/en/nursing/hypoglycaemia-recognising-it-and-the-nursing-response-conscious-and-unconscious/)
- [Giving insulin safely: types by action, pens and syringes, sites, rotation and storage](https://durgical.com/en/nursing/giving-insulin-safely-types-by-action-pens-and-syringes-sites-rotation-and-stora/)

## Related conditions 2

- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Managing Sick Days](https://www.cdc.gov/diabetes/living-with/managing-sick-days.html) (Centers for Disease Control and Prevention (CDC), 2024); [Guía de práctica clínica para el diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo II en la población mayor de 18 años (GPC-2015-51), versión para pacientes](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/CA/gpc-pacientes-diabetes-mellitus-tipo2-poblacion-mayor-18-anos.pdf) (Ministerio de Salud y Protección Social de Colombia, 2015); [16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC11635037/) (American Diabetes Association Professional Practice Committee, Diabetes Care (PMC), 2025); [Hyperglycaemic crises in adults with diabetes: a consensus report](https://pmc.ncbi.nlm.nih.gov/articles/PMC11343900/) (Umpierrez GE et al., Diabetologia (CC BY 4.0, PMC), 2024).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/diabetes-self-management-teaching-before-discharge-monitoring-food-activity-and/