What is a normal blood glucose level in a hospital setting?

Normal Blood Glucose Targets in Hospitalized Patients

For most hospitalized patients, the target blood glucose range should be 140-180 mg/dL (7.8-10.0 mmol/L), with insulin therapy initiated when blood glucose levels persistently exceed 180 mg/dL. 1

Target Ranges Based on Patient Status

Critically Ill Patients

• Target range: 140-180 mg/dL (7.8-10.0 mmol/L) 1
• Intravenous insulin infusion is recommended when blood glucose exceeds 180 mg/dL
• Once insulin therapy is initiated, maintain glucose within this range
• Lower targets (110-140 mg/dL) may benefit select patients if achievable without significant hypoglycemia 1, 2
• Targets <110 mg/dL should be avoided due to increased risk of hypoglycemia and mortality 2

Non-critically Ill Patients

• Target range: 140-180 mg/dL (7.8-10.0 mmol/L) for random blood glucose 1
• Premeal glucose targets should be <140 mg/dL (7.8 mmol/L) 1
• Consider reassessing insulin regimen if blood glucose falls below 100 mg/dL (5.6 mmol/L) 1
• Modify regimen when blood glucose values are <70 mg/dL (3.9 mmol/L), unless explained by factors like missed meals 1

Special Considerations

Patient-Specific Target Adjustments

• More stringent targets (110-140 mg/dL) may be appropriate for:

  • Selected stable patients with previous tight glycemic control 1
  • Post-surgical or cardiac surgery patients 2
  • Only if achievable without significant hypoglycemia 1

• Higher targets may be appropriate for:

  • Terminally ill patients (up to 250 mg/dL) 1, 2
  • Patients with severe comorbidities (up to 200-250 mg/dL) 1, 2
  • Settings where frequent glucose monitoring or close nursing supervision isn't feasible 1

Hypoglycemia Definitions and Prevention

• Hypoglycemia alert value: ≤70 mg/dL (3.9 mmol/L) 1
• Clinically significant hypoglycemia: <54 mg/dL (3.0 mmol/L) 1
• Severe hypoglycemia: Associated with severe cognitive impairment regardless of blood glucose level 1

Monitoring Recommendations

• For patients eating meals: Check glucose before meals 1
• For patients not eating: Check glucose every 4-6 hours 1
• For patients on IV insulin: More frequent testing (every 30 min to 2 hours) 1

Important Clinical Considerations

Mortality Implications

• Recent research suggests that for non-diabetic critically ill patients, maintaining blood glucose in tighter ranges (70-120 mg/dL) for at least 40% of the time may improve survival 3
• Time in range 70-140 mg/dL >80% has been strongly associated with increased survival in non-diabetic critically ill adults 4
• However, the standard hospital target range of 140-180 mg/dL remains the evidence-based recommendation for most patients 1

Common Pitfalls to Avoid

1. Using sliding scale insulin alone - This approach is strongly discouraged 1, 2
2. Setting targets too low - Targets <110 mg/dL increase hypoglycemia risk without clear benefit 2
3. Not adjusting targets for patient-specific factors - Consider comorbidities, terminal status, and prior glycemic control 1
4. Failing to monitor closely - Regular monitoring is essential, especially when initiating or adjusting insulin therapy 1

Insulin Management

• Basal-bolus insulin regimen is preferred over sliding scale insulin alone 2
• For patients with poor oral intake or NPO status, use basal plus correction insulin 1
• For patients with good nutritional intake, use insulin regimen with basal, nutritional, and correction components 1

By following these evidence-based guidelines for blood glucose targets in hospitalized patients, clinicians can optimize outcomes while minimizing the risks of both hyperglycemia and hypoglycemia.