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The Feb. 15 study also concluded that using intensive insulin therapy to significantly lower blood sugar levels isn’t associated with greater improvements in health outcomes.
“The evidence isn’t clear on what range of blood sugar is best, but 140 to 200 mg/dL seems to minimize the risk of hypoglycemia [in surgical or medical units],” said Qaseem. “We felt it was better to stick with a range that is a little bit higher.”
Dr. Mary Korytowski, a professor of medicine at the University of Pittsburgh School of Medicine, and a member of the board of directors of the American Diabetes Association, said that intensive insulin management in medical and surgical units isn’t the best way to manage blood sugar any more.
But, Korytowski said, “200 mg/dL is probably too high. The 2009 ADA/AACE guidelines recommend 180 mg/dL, which is consistent with postprandial numbers in diabetes care.”
The problem is that if you set the target too high, those numbers may be even higher when someone starts giving insulin to bring those numbers down, she explained.
“These guidelines should not be interpreted to mean that glucose control isn’t important for critically ill patients: It is. And it’s important not to let the blood sugar get too high because of the risk of complications, like a higher risk of infection and fluid and electrolyte abnormalities,” she said.
And, she added, that it’s important to remember these guidelines give a range of options. “Managing blood sugar closer to the lower end is probably better,” she concluded.
More information
Read about how illness can affect blood sugar levels in people with diabetes from the .
SOURCES: Amir Qaseem, M.D., Ph.D., director, clinical policy, medical education division, American College of Physicians, Philadelphia; Mary Korytkowski, M.D., professor, medicine, University of Pittsburgh School of Medicine, and member, board of directors, American Diabetes Association; Feb. 15, 2011, Annals of Internal Medicine
Last Updated: Feb. 16, 2011
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