Insulin Therapy in Hospitalized Patients

Hyperglycemia occurs frequently in hospitalized patients and many studies have shown that hyperglycemia is associated with poor outcomes. Until recently was considered that hyperglycemia does not significantly influence the patients outcome. This changed with the publication of Van den Berghe study, which demonstrated significant reduction in mortality with intensive glycemic management. Recent studies have shown that targeting near euglycemia is associated with higher rates of severe hypoglycemia with no reduction in mortality. The consensus statement from American Association of Clinical Endocrinologists and American Diabetes Association recommends a target glucose range of 140–180 mg/dl in most hospitalised patients. Intravenous insulin infusions are recommended for critically ill patients and subcutaneous insulin algoritms with basal and rapidor short-acting insulin administered before meals are recommended for non-critically ill patients. The American Heart Association Diabetes Committee recommendation is that in patients with acute coronary syndrome admitted to an ICU intensive glucose control, using insulin administered as an intravenous infusion, should be considered if plasma glucose is > 180 mg/dl. Recommended range for plasma glucose is 90–140 mg/dl, as long as hypoglycemia is avoided. In patients hospitalized in the non-ICU setting plasma glucose levels should be < 180 mg/dl with subcutaneous insulin regimens. The European Stroke Organisation guidelines for management of ischemic stroke published in 2008 recommend treatment of blood glucose levels > 180 mg/dl with insulin.