Inpatient glycemic management

Last reviewed: 26 Aug 2023
Last updated: 14 Mar 2023



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)
More key diagnostic factors

Other diagnostic factors

  • history of recent corticosteroid use
  • signs of diabetic retinopathy
  • signs of diabetic neuropathy
  • polyuria, polydipsia, or unintentional weight loss
Other diagnostic factors

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)
More risk factors

Diagnostic investigations

1st investigations to order

  • random plasma glucose
  • HbA1c
  • serum BUN, creatinine, and GFR calculation
  • spot urine albumin/creatinine ratio
  • serum ketones
More 1st investigations to order

Investigations to consider

  • post-discharge fasting plasma glucose or HbA1c
  • post-discharge oral glucose tolerance test
More investigations to consider

Treatment algorithm


critically ill or unplanned surgery or in ICU: hyperglycemia

stable noncritical illness: uncontrolled hyperglycemia

stable noncritical illness: well-controlled known diabetes


preoperative: minor elective surgery



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

Professor of Medicine

Director of Endocrinology, Main Campus

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic




MCL has received funding from Dexcom and Abbott for research.

Keren Zhou, MD

Clinical Assistant Professor of Medicine

Research Director, Endocrinology and Metabolism Institute

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic




KZ declares that she has no competing interests


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.


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

Peer reviewers

Guillermo E. Umpierrez, MD

Professor of Medicine

Division of Endocrinology

Metabolism and Lipids

Emory University School of Medicine




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




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




SD declares that he has no competing interests.

  • Differentials

    • Transient hyperglycemia (e.g., from stress, corticosteroids, parenteral/enteral nutrition)
    • Type 1 diabetes mellitus
    • Type 2 diabetes mellitus
    More Differentials
  • Guidelines

    • Standards of care in diabetes - 2023
    • Management of hyperglycemia in hospitalized patients in non-critical care settings
    More Guidelines
  • Patient leaflets

    Diabetes: what is it?

    Diabetes type 2: should I take insulin?

    More Patient leaflets
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