PATIENTS WITH DIABETES are

often our most challenging. Although diabetes isn’t usually the reason that patients are admitted to the hospital, it’s the fourth most common comorbidity. Half of patients with type 1 and 2 dia-betes will face surgery in their lifetime.1 During hospitalization, up to 12% of patients who don’t have a history of diabetes will develop hyperglycemia, which is defined as a fasting blood glucose over 126 mg/dL or a random glucose over 200 mg/dL. Surprisingly, these patients will have a nearly 18-fold increased risk of in-hospital mor-tality compared with the 3-fold risk experienced by patients known to have diabetes.2 Recent studies have demon-strated that better glycemic control can greatly reduce mortality, morbidity, and hospital costs.1 So how tight should glycemic con-trol in hospitalized patients be? Based on recent studies, the answer to that question remains controversial. This article will explore this issue and pre-sent current best practices for caring for a patient in the hospital who has diabetes or hyperglycemia. Why “sweet ” patients go sour Physiologic metabolic responses to acute injury and stress can even cause hyperglycemia in hospitalized patients who don’t have diabetes. Conditions such as a myocardial infarction, stroke, surgery, trauma, pain, and sepsis often How tight Consider the latest evidence as you explore the controversial issue of glycemic control in critically ill patients