The American College of Physicians has released new guidelines recommending that doctors not attempt intensive insulin therapy designed to achieve normal blood sugar levels in patients in medical or surgical intensive care units.

• Doctors should maintain blood sugar levels between 140 and 200 milligrams per deciliter (mg/dL) for anyone in medical or surgical intensive care.
• These recommendations are similar to the guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). However, those guidelines recommend that blood sugar levels should be kept below 180 mg/dL to reduce the risk of infection and other complications.
• In a healthy person with type 2 diabetes, normal blood sugar levels would be between 70 mg/dL and 130 mg/dL before eating and after eating it should be under 180 mg/dL.
• High blood sugar is a common finding in hospitalized patients, and it’s associated with a lot of complications, like delayed healing, increased infection, cardiovascular events, etc
• The prevailing thought in the past was that tightly controlling the blood sugar levels would reduce inflammation, clotting and other problems. But, there are also harms that are associated with lowering the blood glucose levels too much.

• Use of intensive insulin therapy comes with an increased risk of low blood sugar (hypoglycemia) which can be deadly.
• Using intensive insulin therapy to significantly lower blood sugar levels isn’t associated with greater improvements in health outcomes.
• 140 to 200 mg/dL seems to minimize the risk of hypoglycemia in surgical or medical units.
• Intensive insulin management in medical and surgical units isn’t the best way to manage blood sugar any more.
• If the target set is too high, those numbers may be even higher when someone starts giving insulin to bring those numbers down
• These guidelines should not be interpreted to mean that glucose control isn’t important for critically ill patients.
• It is important to 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.
• Managing blood sugar closer to the lower end is probably better.

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