From the Guidelines
For hospitalized diabetic patients, serum glucose targets should generally be maintained between 140-180 mg/dL (7.8-10.0 mmol/L). This range balances the risks of hypoglycemia with the benefits of glycemic control, as supported by the most recent guidelines from 2025 1. The recommendation to initiate insulin therapy for treatment of persistent hyperglycemia ≥180 mg/dL ($10.0 mmol/L) and target a glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill individuals with hyperglycemia is based on the findings from the NICE-SUGAR trial and several meta-analyses 1.
Some key points to consider in managing serum glucose levels in hospitalized diabetic patients include:
- More stringent glycemic goals, such as 110–140 mg/dL (6.1–7.8 mmol/L), may be appropriate for selected individuals, such as critically ill individuals undergoing cardiac surgery, if they can be achieved without significant hypoglycemia 1.
- Less stringent targets may be needed for critically ill patients or those with severe comorbidities, with glucose concentrations between 180 mg/dL and 250 mg/dL (10–13.9 mmol/L) potentially being acceptable in certain situations 1.
- Management typically involves basal-bolus insulin regimens, with blood glucose monitored before meals and at bedtime, and additional checks for symptoms of hypoglycemia or in critically ill patients.
- Medication adjustments should be made gradually based on glucose patterns, with particular attention to preventing nocturnal hypoglycemia.
Overall, the goal is to balance the risks of hypoglycemia with the benefits of glycemic control, and to individualize treatment based on the specific needs and circumstances of each patient, as supported by the most recent and highest quality evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Serum Glucose Targets for Diabetic Patients in the Hospital
- The target serum glucose level for diabetic patients in the hospital varies depending on the patient's condition and the hospital setting 2, 3, 4.
- For critically ill patients, the recommended serum glucose target is between 140 and 180 mg/dL 2, 3, 4.
- In non-critically ill patients, the premeal serum glucose target is less than 140 mg/dL, and random serum glucose levels should be less than 180 mg/dL 4.
- Some studies suggest that tighter glycemic control (i.e., 110-140 mg/dL) may be appropriate for certain patients, such as those with neurological or surgical conditions, if hypoglycemia can be properly avoided 3.
- It is essential to avoid hypoglycemia, and insulin regimens should be reassessed if serum glucose levels fall to less than 100 mg/dL 4.
Glycemic Control Strategies
- Intravenous (IV) insulin is the most appropriate treatment for critically ill patients, with a starting threshold no higher than 180 mg/dL 2, 4.
- For non-critically ill patients, basal-bolus regimens with basal, prandial, and correction components are preferred for those with good nutritional intake, while a single dose of long-acting insulin plus correction insulin is preferred for patients with poor or no oral intake 2.
- Scheduled subcutaneous insulin is the treatment of choice for hyperglycemia in non-critically ill patients, and the use of sliding-scale insulin is strongly discouraged 4.