Management of hyperglycemia in the hospital setting

A 53-year-old woman with asthma and multilobar pneumonia is admitted with respi-ratory failure. She is intubated and treated with antibiotics, albuterol, and methyl-prednisolone. A random blood glucose measurement obtained on admission shows a level of 183 mg per deciliter (10.2 mmol per liter). After 3 hours in the intensive care unit, she has a capillary glucose level of 264 mg per deciliter (14.7 mmol per liter). She has no history of diabetes. Should her hyperglycemia be treated, and if so, how? The Cl inic a l Probl em Until recently, hyperglycemia in hospitalized patients was considered to be little more than a paraphenomenon of illness. However, evidence that in certain circumstanc-es aggressive therapy may improve clinical outcomes has brought increased atten-tion to glucose management in the inpatient setting.1-3 The relationship between hyperglycemia and acute illness is a complex one.1,3,4 Hyperglycemia is frequently encountered during hospitalization owing to increases in patients ’ circulating concentrations of stress hormones. In experimental models, severe hyperglycemia (generally characterized as a glucose level greater than abou