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The diagnosis of diabetes mellitus in the ICU is commonly missed given the incidence of hyperglycemia due to secondary causes. One study showed that 26% of diabetic patients were undiagnosed during their admission to the ICU. These patients had a higher likelihood of requiring an insulin infusion, higher average blood glucose, an increased percentage of hyperglycemia and hypoglycemia (i.e. higher glycemic variability), and increased mortality. These findings suggest that a high suspicion of diabetes in order to anticipate insulin requirement might be beneficial.

Due to glycemic variability in the critically ill patient, routine monitoring, sometimes continuous, is recommended. A patient who is normoglycemic on admission may not remain so throughout their ICU stay and may even require an insulin infusion at some point depending on the degree of hyperglycemia. Therefore routine glucose measurements are recommended during critical illness with strict guidelines on initiation of insulin therapy.