Management of Hyperglycemia in the Noncritical Care Setting

Key Points

  • Hyperglycemia is associated with poor outcomes in noncritically ill patients.

  • Glycemic goals for noncritically ill patients

    • Premeal blood glucose: <140 mg/dL

    • Random blood glucose: <180 mg/dL

    • Reassess insulin regimen if blood glucose is <100 mg/dL, and adjust insulin regimen if blood glucose is <70 mg/dL (unless explained by a missed meal or other specific factors)

  • Insulin therapy is preferred for the majority of acutely ill patients with diabetes; oral antihyperglycemic agents and noninsulin injectable agents should be discontinued upon hospital admission.

  • While some institutions have successfully implemented insulin infusion safely on general wards with modifications (including intensive staff education and adequate staff support), the most common method to administer insulin in the non-ICU setting is use of scheduled subcutaneous insulin administration.

  • Protocols should include point of care (ie, bedside) testing of blood glucose using devices that have demonstrated accuracy in acutely ill patients.

    • Blood glucose should be tested before meals and at bedtime in patients who are eating.

    • Blood glucose should be tested every 4-6 hours in patients who are NPO or continuous enteral nutrition.

  • Protocols should include specific directions for the recognition and management of hypoglycemia (blood glucose <70 mg/dL); this should include nurse-initiated treatment to promptly address any episode of hypoglycemia.

  • The use of sliding scale insulin is to be discouraged as it is a “reactive” and nonphysiologic approach to glycemic control.

Suggested Reading

Clinical Guidelines

Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353-369.

Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154:260-267.

Society of Hospital Medicine. The case for supporting inpatient glycemic control programs now: the evidence and beyond. 2008.

Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16-38.

Additional Reading

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