In hospitalized patients with persistent hyperglycemia, what threshold should be used to start insulin therapy and what should be the target glucose range?

In hospitalized patients with persistent hyperglycemia, what threshold should be used to start insulin therapy and what should be the target glucose range?

• A. Initiate insulin at 140 mg/dL with a target of 100-140 mg/dL
• B. Initiate insulin at 180 mg/dL with a target of 140-180 mg/dL
• C. Initiate insulin at 200 mg/dL with a target of 180-200 mg/dL
• D. Initiate insulin at 150 mg/dL with a target of 140-200 mg/dL

Answer: (B)

When patients are hospitalized and hyperglycemia persists, insulin is used to quickly and safely bring glucose under control. Starting insulin at a glucose level of 180 mg/dL helps avoid overtreatment that could cause dangerous drops in blood sugar, while still addressing the ongoing hyperglycemia. The preferred target range is 140-180 mg/dL because it strikes a balance: it lowers the risks associated with high glucose (infections, poor wound healing, hemodynamic instability) without pushing toward tighter control that increases the chance of hypoglycemia. The other options either start insulin too early or set targets that are either too lenient or too tight, making them less safe or effective in the general inpatient population.

When patients are hospitalized and hyperglycemia persists, insulin is used to quickly and safely bring glucose under control. Starting insulin at a glucose level of 180 mg/dL helps avoid overtreatment that could cause dangerous drops in blood sugar, while still addressing the ongoing hyperglycemia. The preferred target range is 140-180 mg/dL because it strikes a balance: it lowers the risks associated with high glucose (infections, poor wound healing, hemodynamic instability) without pushing toward tighter control that increases the chance of hypoglycemia. The other options either start insulin too early or set targets that are either too lenient or too tight, making them less safe or effective in the general inpatient population.