Diabetes Mellitus and Hyperglycemia Management in the Hospitalized Patient

•Diabetes mellitus and hyperglycemia are common comorbidities in hospitalized patients.•Subcutaneous insulin is the preferred treatment for hyperglycemia in non–critically ill patients.•Understanding insulin pharmacodynamics allows tailoring of insulin therapy to match daily glucose excursions.•Glucose targets of 140-180 mg/dL are recommended for most hospitalized patients.•Prolonged hyperglycemia or hypoglycemia in the hospital can be deleterious.

Diabetes mellitus and hyperglycemia are common in hospitalized patients. Uncontrolled hyperglycemia during hospitalization is associated with poor outcomes. A glucose goal of 140-180 mg/dL is recommended. Scheduled subcutaneous insulin with basal, prandial, and correction components is preferred for treating diabetes in non–critically ill patients. The pharmacodynamics of insulins differ, and the type of insulin used should match daily glucose excursions. Varying hospital settings may warrant using a particular insulin type to achieve optimal glucose control. Herein we describe approaches to address hyperglycemia in the hospitalized patient on the basis of insulin pharmacodynamic profiles.