Insulin Management in Hospital Settings

Target Blood Glucose Range and Protocol Characteristics

The American Diabetes Association recommends targets of 140-180 mg/dL for most ICU patients, with more stringent goals of 110-140 mg/dL appropriate for select patients, according to the American Diabetes Association guidelines 1, 2
The Yale protocol uses validated written or computerized protocols that allow predefined adjustments in insulin infusion rate based on glycemic fluctuations, as recommended by the American Diabetes Association 1, 3

Administer subcutaneous basal insulin 2 hours before discontinuing IV infusion to minimize rebound hyperglycemia, as suggested by the American Diabetes Association 1, 3
Calculate total daily subcutaneous dose based on 60-80% of the insulin infusion rate during the prior 6-8 hours when stable glycemic goals were achieved, according to the American Diabetes Association guidelines 1, 4

The American Diabetes Association strongly discourages the use of sliding scale insulin alone, as it results in poorer glycemic control and increased complications 5, 6
For patients eating regular meals, use a basal-bolus approach starting at 0.5 units/kg basal insulin, as recommended by the American Diabetes Association 5, 6

Never use sliding scale insulin alone as the sole regimen, as it increases both hypoglycemia and hyperglycemia risk and worsens hospital complications, according to the American Diabetes Association guidelines 5, 2, 6
Implement a standardized hospital-wide hypoglycemia management protocol, as recommended by the Joint Commission and the American Diabetes Association 1, 3
Discontinue SGLT2 inhibitors 3-4 days before surgery and avoid during hospitalization, as suggested by the American Diabetes Association 6