Table 11—

Summary of major recommendations for hospital management of hyperglycemia

RecommendationLevel of evidence
• Good metabolic control is associated with improved hospital outcomes. Target plasma glucose levels are:B
 •<110 mg/dl preprandial and <180 mg/dl peak postprandial.
• Intensive insulin therapy with intravenous insulin, with the goal of maintaining blood glucose 80–110 mg/dl, reduces morbidity and mortality among critically ill patients in the surgical ICU.A
• Intravenous insulin infusion is safe and effective for achieving metabolic control during major surgery, hemodynamic instability, and NPO status.B
• Intravenous insulin infusion is safe and effective for patients who have poorly controlled diabetes and widely fluctuating blood glucose levels or who are insulin deficient or severely insulin resistant.B
• Intravenous insulin infusion, followed by multidose subcutaneous insulin therapy, improves survival in diabetic patients after myocardial infarction.A
• For insulin-deficient patients, despite reductions or the absence of caloric intake, basal insulin must be provided to prevent diabetic ketoacidosis.B
• Use of scheduled insulin improves blood glucose control compared with orders based on sliding scale insulin coverage alone.B
• For patients who are alert and demonstrate accurate insulin self-administration and glucose monitoring, insulin self-management should be allowed as an adjunct to standard nurse-delivered diabetes management.E
• Patients with no prior history of diabetes who are found to have hyperglycemia (random blood glucose >125 mg/dl or 6.9 mmol/l) during hospitalization should have follow-up testing for diabetes within 1 month of hospital discharge.E
• Establishing a multidisciplinary team that sets and implements institutional guidelines, protocols, and standardized order sets for the hospital results in reduced hypoglycemic and hyperglycemic events.B
• Diabetes education, medical nutrition therapy, and timely diabetes-specific discharge planning are essential components of hospital-based diabetes care.C