Management of diabetes and hyperglycemia in the hospital: A practical guide to subcutaneous insulin use in the non-critically ill, adult patient

R ecently, there has been a heightened interest in improvingthe quality and safety of the management of diabetes and hyperglycemia in the hospital.1 While observational data strongly suggests an association of hyperglycemia with morbidity and mortality in adults on general medicine and surgery units, clini-cal research has not yet defined the best practices for managing hyperglycemia in the hospital outside the intensive care unit (ICU). As a result, many physicians do not have a well-formu-lated approach to managing hyperglycemia in the noncritically ill hospital patient, and the use of insulin therapy to attain tar-geted blood glucose (BG) control is often subject to practice var-iability, leading to suboptimal glycemic outcomes. Practical ‘‘guidelines’ ’ for the management of this common clinical problem have been formulated by experts in the field, based on understanding of the physiology of glucose and insulin dynamics, the characteristics of currently available insulin pre-