Probable explanation: hospital diabetes care, at most hospitals, is geared for safe institutional care of adult Type II diabetics. This is likely not "carb restricted" as such, but what's also known as a "consistent carbohydrate diet."
If it's restricted at all, or listed on the menu as "carb restricted," it means that they won't let you order infinite pancakes. Usually the selection menu will have carbohydrate numbers (sometimes exchanges or "carb choices") listed after each item, and a total at the bottom. You can circle as many "toast (15)" and "apple juice (15)" as you want, but if you go hog wild, Dietary will only send you items up to your carb level.
Inpatient diabetic diets are utterly wack for Type I diabetics or Type II diabetics who are conscientious and self-motivated and really do eat low carbohydrate diets at home. They're designed for standardized care of Type II diabetics on orals + sliding scale, or with routine basal/prandial insulin (and probably also sliding scale). If every diabetic patient's meal is 45 grams of carbohydrate (and inpatient activity level is pretty standard) you've taken one variable out of their glucose management, and it's just a question of adjusting detemir/glargine and which step of the sliding scale for a particular patient.
There is also the psychosocial factor. If you offer Grandpa a moderate serving of hash browns, he'll grumble, but if you tell him "it's cauliflower rice time lol" he'll fucking riot.