Hyperglycemia frequently occurs with acute medical illness, especially among patients with
cardiovascular disease, and has been linked to increased morbidity and mortality in
critically ill patients. Even patients who are normoglycemic can develop
hyperglycemia in response to acute metabolic stress. An expanding body of literature describes the benefits of normalizing
hyperglycemia with
insulin therapy in hospitalized patients. As a result, both the American Diabetes Association and the American College of Endocrinology have developed guidelines for optimal control of
hyperglycemia, specifically targeting
critically ill, hospitalized patients. Conventional
blood glucose values of 140-180 mg/dL are considered desirable and safely achievable in most patients. More aggressive control to <110 mg/dL remains controversial, but has shown benefits in certain patients, such as those in
surgical intensive care.
Intravenous infusion is often used for initial
insulin administration, which can then be transitioned to subcutaneous
insulin therapy in those patients who require continued
insulin maintenance. This article reviews the data establishing the link between
hyperglycemia and its risks of morbidity and mortality, and describes strategies that have proven effective in maintaining
glycemic control in high-risk hospitalized patients.