Management in the Noncritical Care Setting
Medical Nutrition Therapy (MNT)
Î The ES recommends including MNT as a component of the glycemic
management program for all hospitalized patients with diabetes and
hyperglycemia. (1|⊕
)
Î The ES suggests that providing meals with a consistent amount of
carbohydrate at each meal can be useful for coordinating doses of rapid-
acting insulin to carbohydrate ingestion. (2|⊕
)
Glycemic Target in the Noncritical Care Setting
Î The ES recommends a premeal glucose target of < 140 mg/dL
(7.8 mmol/L) and a random BG of < 180 mg/dL (10.0 mmol/L) for the
majority of hospitalized patients with noncritical illness. (1|⊕⊕
)
Î For avoidance of hypoglycemia, the ES suggests reassessing antidiabetic
therapy when BG values fall below 5.6 mmol/L (100 mg/dL).
Note: Modification of glucose-lowering treatment is usually necessary when BG values
are < 3.9 mmol/L (70 mg/dL). (2|⊕
)
Î The ES suggests modifying glycemic targets according to clinical status.
• For patients who are able to achieve and maintain glycemic control without
hypoglycemia, a lower target range may be reasonable.
• For patients with terminal illness and/or with limited life expectancy or at high risk
for hypoglycemia, a higher target range (BG < 11.1 mmol/L or 200 mg/dL) may be
reasonable. (2|⊕
)
Transition from Hospital to Home
Î The ES suggests reinstituting the preadmission insulin regimen or oral
and noninsulin injectable antidiabetic drugs at discharge for patients with
acceptable preadmission glycemic control and without a contraindication
to their continued use. (2|⊕
)
Î The ES suggests that the regimen the patient will be on after the transition
should be started prior to discharge whenever possible. (2|⊕
)
Î The ES recommends giving patients and their family or caregivers both
written and oral instructions regarding the glycemic management regimen
at the time of hospital discharge. (1|⊕⊕
)
Note: These instructions need to be clearly written in a manner that is understandable to
the person who will administer these medications.
