by jaundiced, do you mean judgemental, that is not at all what I meant- I mean tighter control of BG inpatient is crucial. You are right- you do not want to overcorrect- but hyperglycemia is not desired either.
Here are some relatively recent guidelines.
"A consensus statement of the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) issues clinical recommendations on the proper treatment of hospitalized patients with high blood glucose levels. The new guidelines, which target healthcare professionals, supporting staff, hospital administrators, and others involved in improved management of hyperglycemia in inpatient settings, are published in the May/June 2009 issue of Endocrine Practice
and in the May issue of Diabetes Care
Medscape: Medscape Access
Recommendations for Critically Ill Patients
Specific clinical recommendations for critically ill patients are as follows:
• For treatment of persistent hyperglycemia, beginning at a threshold of no greater than 180 mg/dL (10.0 mmol/L), insulin therapy should be started.
• For most critically ill patients, a glucose range of 140 to 180 mg/dL (7.8 - 10.0 mmol/L) is recommended once insulin therapy has been started.
• To achieve and maintain glycemic control in critically ill patients, the preferred method is intravenous insulin infusions.
• Validated insulin infusion protocols that are shown to be safe and effective and to have low rates of hypoglycemia are recommended.
• To reduce hypoglycemia and to achieve optimal glucose control, frequent glucose monitoring is essential in patients receiving intravenous insulin.
The article goes on with guidelines for less critically ill patients.
Our hospital has sets of guidelines based on how insulin- sensitive each patient is. Outpatient- I have patients who use 300+ units a day, and some that use only a tenth of that.