• The goal in a hospitalized diabetic is not necessarily to achieve "tight" control. That is a long term, outpatient issue.
• The reasons to avoid extreme hyperglycemia in the acute, hospitalized setting are to 1) prevent dehydration and osmotic diuresis, 2) prevent the development of DKA or HONKC, and 3) enhance phagocytic function and wound healing.

• Excessive hyperglycemia can be expected in diabetics admitted with a metabolically stressful illness or in those receiving corticosteroids.
• Type 2 diabetics who are NPO should have their oral agents and insulin held.

Assuming the patient is not in DKA, consider the following options:

1. Address the acute hyperglycemia with regular "coverage", using the following scale:

240. 3-5 u sq

400. 8-10 u sq

2) Address the chronic hyperglycemic state:

• If the patient is on oral meds, one can increase the dose. This applies only to sulfonureas, as the other oral agents take days to work. If a patient is on $ 10mg of glyburide or glipizide, this strategy will not be effective.
• Alternatively, one can simply add a 0.3-0.5 u/kg dose of intermediate acting (NPH) insulin at bedtime.

• Another option, if persistent hyperglycemia is noted, is to place the patient on a standing dose of NPH 0.5 u/kg, split 2/3 in AM, 1/3 at bedtime. This can be titrated upwards over the course of the hospitalization.