Management of Elevated Blood Glucose in the Ward

Initial Assessment and Monitoring

The American Diabetes Association recommends that all patients with known diabetes require blood glucose monitoring 1, 3, 4
Patients with admission blood glucose >140 mg/dL (7.8 mmol/L) should be monitored 3, 5, 4
The American Diabetes Association suggests that patients receiving glucocorticoid therapy should have their blood glucose monitored 3, 4

The American Diabetes Association recommends targeting blood glucose 100-180 mg/dL for non-critically ill patients 1, 2, 3, 5, 4
The American Diabetes Association suggests that pre-meal targets should be <140 mg/dL (7.8 mmol/L) 5

The American Diabetes Association recommends a scheduled basal-bolus insulin regimen with basal insulin (glargine or detemir), prandial rapid-acting insulin (lispro, aspart, or glulisine) before meals, and correction doses for non-critically ill patients 1, 2, 3
The American Diabetes Association suggests that basal insulin should be administered at 0.2-0.25 units/kg once daily 7, 8
The American Diabetes Association recommends that prandial insulin should be administered before each meal at 0.1-0.15 units/kg divided into three doses 7, 8

The American Diabetes Association defines moderate hypoglycemia as blood glucose <70 mg/dL 1, 3, 4
The American Diabetes Association defines severe hypoglycemia as blood glucose <54 mg/dL or requiring assistance 1, 3, 4
The American Diabetes Association recommends treating hypoglycemia with oral carbohydrate or glucose for conscious patients 1, 3, 4

The American Diabetes Association recommends consulting diabetes specialists or inpatient glucose management teams for complex hyperglycemia management 1, 3, 4

The American Diabetes Association recommends returning to home regimens 1-2 days before discharge 6, 1
The American Diabetes Association suggests scheduling outpatient follow-up within 1 week to 1 month 1, 4

The American Diabetes Association recommends evaluating for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) in patients with severe hyperglycemia 8, 9
The American Diabetes Association suggests initiating IV fluid resuscitation with 0.9% sodium chloride and starting continuous IV insulin infusion targeting 140-180 mg/dL 8, 9