Management of hyperglycaemia in the hospitalised patient

The two numbers

Insulin therapy should be initiated in hospitalized patients with persistent hyperglycemia, starting at a threshold of 180 mg/dL. Once insulin therapy is started, a target glucose range of 140 to 180 mg/dL is recommended for the majority of hospitalized patients.

The number to start at and the top of the target range are the same number, 180 mg/dL, and that is what makes 180 mg/dL the maximum blood glucose goal on the ward.

The range is recommended regardless of whether the patients have a critical illness. So the setting does not move it: a 75-year-old admitted to the intensive-care unit with sepsis, with diabetes mellitus and coronary artery disease, is held to the same maximum as the patient on the general ward, not to a lower goal such as 100 mg/dL and not to a higher one such as 220 mg/dL.

The regimen that carries the day-to-day care

The insulin regimen considered the best for the day-to-day management of diabetes is basal-bolus: long-acting basal at night, rapid at meals.

The reason given is that it is similar to physiological insulin, which exists at a baseline level, with insulin spikes that occur after a meal.