What is the normal blood sugar range for in-patients?

Normal Blood Sugar Ranges for Hospitalized Patients

For hospitalized patients, the recommended blood glucose target range is 140-180 mg/dL (7.8-10.0 mmol/L) for both critically ill and non-critically ill patients. 1

Different Target Ranges Based on Patient Status

Critically Ill Patients

• Standard target range: 140-180 mg/dL (7.8-10.0 mmol/L) 1
• Insulin therapy should be initiated when blood glucose is ≥180 mg/dL (10.0 mmol/L) 1
• Requires intravenous insulin protocol with demonstrated efficacy and safety 1
• More stringent goals of 110-140 mg/dL (6.1-7.8 mmol/L) may be appropriate for selected patients (e.g., cardiac surgery patients) if achievable without significant hypoglycemia 1

Non-Critically Ill Patients

• Standard target range: 140-180 mg/dL (7.8-10.0 mmol/L) 1
• Pre-meal blood glucose targets: <140 mg/dL (7.8 mmol/L) 1
• Random blood glucose targets: <180 mg/dL (10.0 mmol/L) 1
• Fasting glucose levels <100 mg/dL are predictors of hypoglycemia within 24 hours 1

Special Populations

• Terminally ill patients: Higher glucose ranges up to 250 mg/dL (13.9 mmol/L) may be acceptable 1
• Patients with severe comorbidities: Less stringent targets may be appropriate 1
• Stable patients with previous tight glycemic control: More stringent targets may be appropriate 1

Definition of Abnormal Blood Glucose in Hospital

• Hyperglycemia: Blood glucose >140 mg/dL (7.8 mmol/L) 1
• Moderate hypoglycemia: Blood glucose <70-72 mg/dL 1
• Severe hypoglycemia: Blood glucose <54 mg/dL 1

Monitoring Recommendations

• Who should be monitored:

  • All patients with known diabetes 1
  • Patients with admission hyperglycemia >140 mg/dL 1
  • Patients on glucocorticoids 1
  • Patients receiving enteral or parenteral nutrition 1

• Frequency of monitoring:

  • Before meals for patients who are eating 1
  • Every 4-6 hours for patients who are not eating 1
  • Every 30 minutes to 2 hours for patients on intravenous insulin 1

Clinical Implications and Pitfalls

• Overly tight glucose control (80-110 mg/dL) has been associated with increased mortality and 10-15 fold greater rates of hypoglycemia 1
• The NICE-SUGAR trial demonstrated that intensive insulin therapy targeting euglycemia increases mortality compared to more moderate glycemic targets 1
• Hypoglycemia in hospitalized patients is associated with higher mortality 1
• For non-diabetic critically ill patients, time in blood glucose range of 70-140 mg/dL >80% is strongly associated with increased survival 2

Treatment Approach

• Insulin is the preferred therapy for persistent hyperglycemia ≥180 mg/dL (10.0 mmol/L) 1
• Basal-bolus insulin regimen is preferred for patients with good nutritional intake 1
• Basal plus correction insulin is preferred for patients with poor oral intake or NPO status 1
• Sole use of sliding scale insulin is strongly discouraged 1

By maintaining blood glucose within the recommended ranges and avoiding hypoglycemia, healthcare providers can optimize outcomes for hospitalized patients with respect to morbidity, mortality, and quality of life.