Management of hyperglycemia in hospitalized noncritical patients

Randomized trials designed to determine optimum blood glucose (BG) levels among hospitalized noncritically ill patients are limited. In this group of patients, experts generally recommend premeal BG targets of 100 to 140 mg/dL, and random BG <180 mg/dL. Scheduled insulin is the mainstay therapy to control hyperglycemia in patients admitted to general wards and should include three components: basal, prandial, and correction insulin. Insulin doses should take into account the severity of hyperglycemia, weight, type of diabetes, age, caloric intake, renal function, and propensity for hypoglycemia. Limited data suggest that the traditional mixed-split insulin regimen formed of neutral protamine hagedorn-regular insulin is similar in efficacy and frequency of hypoglycemia to a more expensive and complex insulin analog regimen formed of twice-daily detemir and mealtime glulisine; however, based on extrapolation of data derived from trials of diabetic outpatients, basal insulin analogs such as glargine or detemir may be used instead of neutral protamine hagedorn insulin if there is concern about hypoglycemia. In patients with erratic meal intake, the use of short-acting insulin analogs may be preferred to regular insulin. Further studies are required to determine the ideal glycemic goals and insulin treatment strategies for control of hyperglycemia in hospitalized noncritically ill patients.