Inpatient Insulin Regimen Selection

Use continuous IV insulin in critical care, where rapid titration is needed as vasopressor requirements, organ perfusion, nutrition, and corticosteroid exposure change. For most ICU patients, target glucose 140-180 mg/dL. A 110-140 mg/dL target is an option only in selected patients—such as cardiac surgical patients or patients with stable control—when the unit has experienced protocols and nursing support and hypoglycemia can be avoided; targets <110 mg/dL are not recommended. PubMed+1PubMedManagement of Diabetes and Hyperglycemia in Hospitalized PatientsPubMedInsulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

Outside critical care, choose subcutaneous insulin according to whether hyperglycemia is transient or sustained and whether the patient has established diabetes. In adults without prior diabetes and hospital glucose >140 mg/dL, begin correctional insulin and target 100-180 mg/dL. Escalate to scheduled basal or basal-bolus insulin when at least two point-of-care glucose values are ≥180 mg/dL within 24 hours despite correctional insulin. PubMed+1PubMedManagement of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline - PMCendocrineInpatient Hyperglycemia Guideline Resources - Endocrine Society

For adults with diabetes previously managed with diet or noninsulin agents, either correctional insulin or scheduled insulin may be used initially, with a 100-180 mg/dL target. The practical discriminator is recurrence: repeated values above target, consistent carbohydrate exposure, enteral nutrition, or corticosteroid-related hyperglycemia favor scheduled insulin rather than repeated reactive doses. endocrine+1endocrineInpatient Hyperglycemia Guideline Resources - Endocrine SocietyPubMedManagement of Glucocorticoid-Induced Hyperglycemia - PMC - NIH

Use basal-prandial-correction insulin for noncritically ill patients with good, consistent oral intake. Basal insulin addresses fasting and between-meal hyperglycemia, prandial insulin covers nutritional carbohydrate exposure, and correction insulin addresses residual excursions. This approach is preferred by inpatient guidance over correction-only insulin in patients eating reliably. PubMed+2PubMedGlycemic Management in Insulin-Naive Patients in the Inpatient Setting - PMCPubMedComparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting - PMCPubMedInpatient and Outpatient Technologies to Assist in the Management of Insulin Dosing

Use basal-plus-correction insulin when the patient is NPO, eating inconsistently, or has uncertain meal timing. Add prandial insulin only after intake becomes consistent. This avoids administering nutritional insulin for meals that are delayed, refused, interrupted for procedures, or incompletely consumed. PubMed+1PubMedGlycemic Management in Insulin-Naive Patients in the Inpatient Setting - PMCPubMedComparison of an Electronic Glycemic Management System Versus Provider-Managed Subcutaneous Basal Bolus Insulin Therapy in the Hospital Setting - PMC

Avoid exclusive sliding-scale or correction-only insulin for established, sustained inpatient hyperglycemia. In a randomized general-medicine comparison, basal-bolus therapy achieved glucose <140 mg/dL in 66% of patients versus 38% with sliding-scale insulin alone; hypoglycemia <60 mg/dL was uncommon in both groups. PubMed+2PubMedManagement of Diabetes and Hyperglycemia in Hospitalized PatientsScienceDirectTop 10 Facts to Know About Inpatient Glycemic ControlPubMedInsulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

Use point-of-care capillary glucose testing before meals and at bedtime for patients who are eating. For patients who are NPO or receiving continuous enteral nutrition, measure glucose every 4-6 hours. These schedules provide the data needed to distinguish fasting, nutritional, and persistent hyperglycemia before changing a regimen. PubMedPubMedInsulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

Increase measurement frequency for continuous IV insulin, after corticosteroid initiation or dose change, after abrupt discontinuation of enteral or parenteral nutrition, and after recurrent hypoglycemia. Each of these situations can rapidly uncouple a previously appropriate insulin dose from current carbohydrate exposure or insulin requirement. PubMedPubMedInsulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

Treat glucose <70 mg/dL as hypoglycemia and glucose <40 mg/dL as severe hypoglycemia. After either event, activate the institutional hypoglycemia protocol, obtain more frequent point-of-care glucose measurements, and reassess the basal, prandial, correction, nutrition, and corticosteroid components before resuming the prior regimen unchanged. PubMedPubMedGlycemic Management in Insulin-Naive Patients in the Inpatient Setting - PMC

For glucocorticoid-associated hyperglycemia in the ward, use basal-bolus insulin with correction doses when feasible; correction-only insulin is retroactive and performs less well than scheduled approaches. Persistent hyperglycemia during enteral nutrition also requires scheduled insulin rather than correction doses alone. ScienceDirect+1ScienceDirectTop 10 Facts to Know About Inpatient Glycemic ControlPubMedManagement of Glucocorticoid-Induced Hyperglycemia - PMC - NIH

A patient using a personal insulin pump may continue self-management only when physically and mentally competent and when institutional processes support safe use. Nursing documentation should include basal rates and bolus doses at least daily. Discontinue the pump and transition to subcutaneous insulin or IV insulin if the patient is not competent or lacks necessary supplies. ScienceDirect+1ScienceDirectIn-Hospital Management of Adults Using Insulin Pump TherapyScienceDirectTop 10 Facts to Know About Inpatient Glycemic Control

Do not assume inpatient nutrition will remain stable. A steroid dose reduction, an interrupted tube feeding, or a new NPO order changes insulin exposure immediately; increase glucose surveillance and reassess scheduled insulin when any of these transitions occurs. PubMedPubMedInsulin Therapy for the Management of Hyperglycemia in Hospitalized Patients