Summary and References

Hyperglycemia is highly prevalent in hospitalized patients and associated with poor clinical outcomes. Stress hyperglycemia occurs in patients with and without diabetes. Insulin therapy is the cornerstone of inpatient diabetes management. Intravenous insulin infusion is preferred for critically ill patients, allowing close titration to achieve glycemic targets. In non-critically ill patients, subcutaneous basal-bolus regimens are highly effective.

Sliding scale insulin alone is inferior to basal, nutritional, and correctional approaches. Current guidelines recommend target glucose levels of 140-180 mg/dL for most critically ill patients to reduce hypoglycemia risk. More stringent targets may be appropriate for selected stable patients if they can be achieved safely.

Noninsulin agents have limited utility during hospitalization. However, metformin is reasonable to continue in stable patients without contraindications. Transition between different routes of insulin delivery is a high-risk period. Hypoglycemia monitoring and prevention are paramount for patient safety. Clinical pharmacists play a vital role in reviewing insulin regimens, educating nurses, and ensuring safe, effective glycemic management across health transitions.

References

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