Pathophysiology and management strategies for hyperglycemia for patients with acute illness during and following a hospital stay

Nicole C. Dombrowski, Dennis G. Karounos

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Hyperglycemia in the inpatient setting is associated with poor clinical outcomes and is often suboptimally managed. This review addresses the pathophysiology of hyperglycemia, current recommendations for management of inpatient hyperglycemia in the general medical and surgical care setting, the transition between different diabetes treatments, and the transition from inpatient to outpatient therapy. The preferred drug for management of inpatient hyperglycemia is insulin. Successful use of intravenous and subcutaneous insulin in the hospital is based on the implementation of standardized protocols. Current guidelines recommend basal-bolus subcutaneous insulin in non-critically ill patients. The methods of switching from intravenous to subcutaneous, sliding-scale to basal-bolus, and biphasic to basal-bolus are discussed. Transition from an inpatient to an outpatient insulin regimen, especially in patients new to insulin therapy, requires special attention to ensure that patients have the knowledge to administer insulin safely and effectively. The optimal regimen at discharge must be individualized. Patients with acute infections may benefit from insulin therapy until the infection is resolved. Strategies to optimize diabetes therapy after discharge are discussed. Prompt outpatient follow-up is crucial to ensure optimal glycemic control. Despite the challenges, improved glycemic control in individuals with acute illness has the potential to reduce morbidity and mortality in individuals with this widespread metabolic illness.

Original languageEnglish
Pages (from-to)326-336
Number of pages11
JournalMetabolism: Clinical and Experimental
Issue number3
StatePublished - Mar 2013

Bibliographical note

Funding Information:
Disclosure: Dennis G. Karounos, MD, Chief, Endocrinology Section, VAMC Lexington and Associate Professor of Internal Medicine, Division of Endocrinology and Molecular Medicine, Department of Physiology, Microbiology, Immunology and Molecular Genetics, and Associate, Graduate Center for Nutritional Sciences, receives research support from the Department of Veterans Affairs Medical Center, Lexington, KY, as well as clinical research grants from Novo Nordisk, Inc., Amylin Pharmaceuticals, Spherix Inc., Osiris Therapeutics, Eli Lilly and Company, Peptor Inc., and Diamyd Therapeutics AB. Nicole C. Dombrowski has no conflicts of interest to disclose. This article does not represent the views of the Department of Veterans Affairs or the United States Government.


  • Basal-bolus insulin therapy
  • Diabetes
  • Glycemic control
  • Insulin

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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