What is the recommended blood sugar target for inpatients?

Inpatient Blood Sugar Target Recommendations

For most 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

Target Ranges by Patient Population

Critically Ill Patients

• Initiate insulin therapy when blood glucose is ≥180 mg/dL (10.0 mmol/L) (checked on two occasions) 1
• Target glucose range: 140-180 mg/dL (7.8-10.0 mmol/L) 1
• Intravenous insulin infusion is the preferred method in ICU settings 1
• More frequent monitoring required: every 30 minutes to 2 hours 1

Non-critically Ill Patients

• Target premeal blood glucose: <140 mg/dL (7.8 mmol/L) 1
• Target random blood glucose: <180 mg/dL (10.0 mmol/L) 1
• Monitoring frequency: before meals for patients who are eating; every 4-6 hours for those not eating 1, 2

Special Considerations

More Stringent Targets (110-140 mg/dL)

May be appropriate for selected patients:

• Critically ill post-surgical patients 1
• Cardiac surgery patients 1, 3
• Patients with acute ischemic cardiac or neurological events 1
• Only if achievable without significant hypoglycemia 1

Less Stringent Targets

May be appropriate for:

• Patients with severe comorbidities 1
• Settings where frequent glucose monitoring is not feasible 1
• Terminally ill patients with short life expectancy (levels >250 mg/dL may be acceptable) 1

Implementation Strategies

Insulin Regimens

• Critically ill: Continuous intravenous insulin infusion 1
• Non-critically ill:
  • Basal plus correction insulin for patients with poor oral intake or NPO 1
  • Basal-prandial-correction insulin regimen for patients with good nutritional intake 1
  • Sliding scale insulin alone is strongly discouraged 1, 2

Monitoring Protocol

• Point-of-care glucose monitoring before meals for patients who are eating 1
• Every 4-6 hours for patients not eating 1
• Every 30 minutes to 2 hours for patients on IV insulin 1

Avoiding Hypoglycemia

• Hypoglycemia is associated with increased mortality 1, 4
• Risk factors for hypoglycemia:
  • Discontinuous nutritional intake 4
  • Low BMI 4
  • Overly aggressive glucose targets 4
• Fasting glucose levels <100 mg/dL are predictors of hypoglycemia within 24 hours 1

Pitfalls to Avoid

• Using sliding scale insulin as the sole regimen 1, 2
• Targeting overly tight glycemic control (80-110 mg/dL) in general populations due to increased risk of severe hypoglycemia 1, 5
• Failing to adjust insulin doses based on clinical status changes, nutritional intake, or medications affecting glucose levels (e.g., glucocorticoids) 1
• Inadequate monitoring frequency, especially with IV insulin therapy 1

Transition of Care

• Diabetes discharge planning should start at hospital admission 1
• Provide clear written and oral instructions regarding insulin dosing and timing 1
• Educate patients on basic skills for home management 1, 5

Remember that while these targets are evidence-based recommendations, clinical judgment should be incorporated into day-to-day decisions regarding insulin dosing based on the patient's clinical status, nutritional intake, and risk factors for hypoglycemia.