Blood Sugar Control in Hospitalized Patients

Target Glucose Ranges

The American Diabetes Association recommends maintaining blood glucose between 140-180 mg/dL to optimize outcomes while minimizing hypoglycemia risk 1, 3
The American College of Clinical Endocrinologists suggests initiating insulin therapy when glucose persistently exceeds 180 mg/dL on two separate measurements 3
More stringent targets of 110-140 mg/dL may be appropriate for select stable patients who can achieve this without significant hypoglycemia, but aggressive targets below 110 mg/dL increase mortality and should be avoided 1, 2

The American Association of Clinical Endocrinologists recommends checking blood glucose before each meal for patients eating meals 1, 3
For patients NPO, the Endocrine Society suggests monitoring every 4-6 hours 1, 3
For patients on IV insulin, the American Diabetes Association recommends monitoring every 30 minutes to 2 hours 2, 3

The European Association for the Study of Diabetes states that oral antidiabetic agents may be continued in hospitalized patients who meet specific criteria, including non-critically ill status, mild-to-moderate hyperglycemia, and adequate renal function 1, 4
The American College of Clinical Endocrinologists recommends transitioning to insulin for critically ill patients, those with severe hyperglycemia, or those with inconsistent oral intake 1, 2, 3

The American Diabetes Association recommends discontinuing metformin in patients with eGFR <30 mL/min/1.73 m² or those at risk for lactic acidosis 4, 6
The Endocrine Society suggests avoiding sulfonylureas in hospitalized patients due to sustained hypoglycemia risk, especially with inconsistent oral intake 4, 5

The American Association of Clinical Endocrinologists recommends using basal-bolus-correction insulin regimen for patients with good oral intake 1, 2, 3
For patients with poor or no oral intake, the American Diabetes Association suggests using basal insulin plus correction doses 1, 2, 3

The American College of Clinical Endocrinologists recommends resuming oral agents 1-2 days before discharge to assess glycemic response while still in hospital 1, 2, 3
The Endocrine Society suggests measuring HbA1c at admission to guide discharge planning, with specific recommendations based on HbA1c levels 3, 5, 7

The American Diabetes Association recommends implementing a standardized hypoglycemia protocol, including nurse-initiated treatment for glucose <70 mg/dL and review of insulin regimen after any glucose reading <70 mg/dL 6, 3
The American Association of Clinical Endocrinologists suggests documenting and tracking all hypoglycemic episodes for quality improvement 6

The National Kidney Foundation recommends lower insulin doses and more frequent glucose monitoring for patients with renal dysfunction 6, 5
The American Diabetes Association suggests avoiding metformin in patients with eGFR <30 mL/min or dose reduction for those with eGFR 30-45 mL/min 5

The American College of Clinical Endocrinologists recommends consulting specialized diabetes or glucose management teams for all hospitalized patients with diabetes to optimize outcomes and reduce complications 1, 2