23
Goals for Blood Glucose Levels in Hospital
Î Critically ill patients:
• Insulin therapy should be initiated for treatment of persistent hyperglycemia
starting at a threshold of ≤180 mg/dL (10 mmol/L). Once insulin therapy is
started, a glucose range of 140-180 mg/dL (7.8-10 mmol/L) is recommended for
most critically ill patients. (A)
• More stringent goals, such as 110-140 mg/dL (6.1-7.8 mmol/L) may be
appropriate for selected patients, as long as this can be achieved without significant
hypoglycemia. (C)
• Critically ill patients require an intravenous insulin protocol that has
demonstrated efficacy and safety in achieving the desired glucose range without
increasing risk for severe hypoglycemia. (E)
Î Noncritically ill patients:
• There is no clear evidence for specific BG goals. If treated with insulin, the
premeal BG target should generally be <140 mg/dL (7.8 mmol/L) with random
BG <180 mg/dL (10.0 mmol/L), provided these targets can be safely achieved.
Note: More stringent targets may be appropriate in stable patients with previous
tight glycemic control. Less stringent targets may be appropriate in those with severe
comorbidites. (E)
• Scheduled subcutaneous insulin with basal, nutritional, and correction
components is the preferred method for achieving and maintaining glucose
control in noncritically ill patients. (C)
Î Glucose monitoring should be initiated in any patient not known
to be diabetic who receives therapy associated with high risk for
hyperglycemia, including high-dose glucocorticoid therapy, initiation
of enteral or parenteral nutrition, or other medications such as
octreotide or immunosuppressive medications. (B) If hyperglycemia
is documented and persistent, consider treating such patients to the
same glycemic goals as patients with known diabetes. (E)
Î A hypoglycemia management protocol should be adopted and
implemented by each hospital or hospital system. A plan for treating
hypoglycemia should be established for each patient. Episodes of
hypoglycemia in the hospital should be documented in the medical
record and tracked. (E)
Î Consider obtaining an A1c in patients with diabetes admitted to the
hospital if the result of testing in the previous 2-3 months is not
available. (E)
Î Patients with hyperglycemia in the hospital who do not have a
diagnosis of diabetes should have appropriate plans for follow-up
testing and care documented at discharge. (E)
