Inpatient Glucose Management Target Range

Standard Target Range

The American Diabetes Association recommends a target glucose range of 140–180 mg/dL for the majority of hospitalized patients, both critically ill and non‑critically ill. Insulin therapy should be initiated when glucose persistently exceeds 180 mg/dL on two separate measurements. 1

The NICE‑SUGAR trial demonstrated that intensive glycemic control aiming for 80–110 mg/dL in critically ill patients resulted in significantly higher mortality compared with a 140–180 mg/dL target. 1
The same trial reported a 10‑ to 15‑fold increase in severe hypoglycemia with the 80–110 mg/dL target. 1
No clinical advantage (e.g., reduced infection or length of stay) was observed with the intensive target versus the moderate target. 1
The Society of Critical Care Medicine explicitly advises never targeting glucose <110 mg/dL in critically ill patients because of the associated mortality risk. 3

Allowing glucose to rise to 200 mg/dL exceeds evidence‑based thresholds and is linked to increased risk of hospital complications. 1

Target: 140–180 mg/dL for most critically ill patients. 5
Insulin initiation: Begin insulin when glucose is ≥180 mg/dL. 1
Protocol: Apply validated intravenous insulin infusion protocols. 5
Selective tighter control: A target of 110–140 mg/dL may be considered for select groups (e.g., post‑cardiac surgery) only if it can be achieved without significant hypoglycemia. 1

Target: 140–180 mg/dL (random glucose <180 mg/dL). 5
Pre‑meal target: <140 mg/dL is reasonable when safely attainable. 5
Insulin regimen: Use scheduled subcutaneous basal‑bolus insulin regimens rather than sliding‑scale insulin alone. 5
Sliding‑scale insulin: Its sole use is strongly discouraged. 5

Hypoglycemia prevention: Do not administer insulin when glucose is <70 mg/dL; this level triggers the hypoglycemia alert requiring immediate treatment with fast‑acting carbohydrates (≈15–20 g). 4
Regimen reassessment: Review and adjust insulin therapy when glucose falls <100 mg/dL to avoid impending hypoglycemia. 4
Severe comorbidities: In patients with major comorbid conditions where frequent monitoring is impractical, a broader range of 180–250 mg/dL may be tolerated. 1
The 140–180 mg/dL target is supported by the NICE‑SUGAR trial and subsequent meta‑analyses as the optimal balance between glycemic control and hypoglycemia risk. 1