Clinical recommendationEvidence ratingReferences
Traditional sliding-scale insulin should be abandoned as the sole means of controlling blood glucose levels in hospitalized patients.B7, 8, 911, 14
Physiologic subcutaneous insulin protocols with basal, nutritional, and correctional components should be used for patients with diabetes mellitus who are hospitalized (non-ICU).B18, 20, 21, 22
Long-acting insulin should be used for physiologic basal insulin.B18, 19, 20, 21, 22
Short-acting insulin should be used for physiologic nutritional and correctional insulin.B18, 20, 21, 22
Discontinuing outpatient oral diabetic medications should be considered upon hospitalization of patients who are not in an ICU.C8, 24, 26
Insulin therapy should be continued upon hospital discharge of capable patients already on two or more oral diabetic medications and with an admission A1C greater than 10 percent.C6, 21, 23
An A1C level should be obtained upon admission if none performed within the past 30 days.C7, 8, 18, 21