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Inpatient glycemic management

Last reviewed: 20 Aug 2025
Last updated: 23 Apr 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of diabetes mellitus
  • severe intercurrent illness or infection (hyperglycemia)
  • insulin use (hypoglycemia)
  • reduced level of consciousness/coma (hypoglycemia and hyperglycemia)
  • sweating (hypoglycemia)
  • tachycardia (hypoglycemia)
  • unusual behavior (hypoglycemia)
Full details

Other diagnostic factors

  • history of recent corticosteroid use
  • signs of diabetic retinopathy
  • signs of diabetic neuropathy
  • polyuria, polydipsia, or unintentional weight loss
Full details

Risk factors

  • severe illness (hyperglycemia or hypoglycemia)
  • corticosteroid use (hyperglycemia)
  • poorly controlled diabetes mellitus (hyperglycemia)
  • insulin administration or insulin secretagogues (hypoglycemia)
  • changes to corticosteroid or insulin regimen (hypoglycemia or hyperglycemia)
  • poor nutritional intake (hypoglycemia)
  • older age or cognitive impairment (hypoglycemia)
Full details

Diagnostic tests

1st tests to order

  • random plasma glucose
  • HbA1c
  • serum BUN, creatinine, and eGFR
  • spot urine albumin/creatinine ratio
  • serum ketones
Full details

Tests to consider

  • post-discharge fasting plasma glucose or HbA1c
  • post-discharge 2-hour postload glucose after 75 g oral glucose
Full details

Treatment algorithm

ACUTE

critically ill or unplanned surgery or in ICU: hyperglycemia

stable noncritical illness: uncontrolled hyperglycemia

stable noncritical illness: well-controlled known diabetes

hypoglycemia

preoperative: minor elective surgery

Contributors

Authors

M. Cecilia Lansang, MD, MPH
M. Cecilia Lansang

Professor of Medicine

Director of Endocrinology, Main Campus

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Disclosures

MCL has received research support from Dexcom, Xeris, and Abbott. She is also a consultant at Glooko.

Keren Zhou, MD

Clinical Assistant Professor of Medicine

Research Director, Endocrinology and Metabolism Institute

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Раскрытие информации

KZ declares that she has no competing interests

Выражение благодарностей

Dr M. Cecilia Lansang and Dr Keren Zhou would like to gratefully acknowledge Dr Suzanne Quinn, Dr Ajay Rao, and Dr Vivian Fonseca, previous contributors to this topic.

Раскрытие информации

SQ, AR, and VF declare that they have no competing interests.

Рецензенты

Guillermo E. Umpierrez, MD

Professor of Medicine

Division of Endocrinology

Metabolism and Lipids

Emory University School of Medicine

Atlanta

GA

Раскрытие информации

GEU is an author of a number of references cited in this monograph.

Daniel Morganstein, MBBS, MA (Cantab), MRCP, PhD

Consultant Diabetologist

Beta Cell Unit

Chelsea and Westminster NHS Trust

London

UK

Раскрытие информации

DM declares that he has no competing interests.

Sean Dinneen, MBBCh, FRCPI, FACP

Senior Lecturer in Medicine

National University of Ireland

Consultant in Diabetes and Endocrinology

Galway University Hospitals

Galway

Ireland

Раскрытие информации

SD declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

American Diabetes Association. Standards of care in diabetes - 2024. Diabetes Care. 2024 Jan;47(suppl 1):S1-321.Полный текст

Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract 2009 May-Jun;15(4):353-69. Аннотация

Pasquel FJ, Lansang MC, Dhatariya K, et al. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol. 2021 Mar;9(3):174-88.Полный текст  Аннотация

Finfer S, Chittock DR, Su SY, et al; NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283-97.Полный текст  Аннотация

Umpierrez G, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007 Sep;30(9):2181-6.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Отличия

    • Transient hyperglycemia (e.g., from stress, corticosteroids, parenteral/enteral nutrition)
    • Type 1 diabetes mellitus
    • Type 2 diabetes mellitus
    Больше Отличия
  • Рекомендации

    • Standards of care in diabetes - 2024
    • Management of individuals with diabetes at high risk for hypoglycemia: clinical practice guideline
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