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 Much controversy surrounds the idea of what constitutes ideal blood glucose targets in the critically ill patient. Multiple trials have yielded contradictory results. Initially, stringent glucose level control was advocated; however this recommendation was challenged because of the recognition that hyperglycemia was the body's way of adapting to stress. In the early 2000s, the Leuven surgical trial concluded that intensive glucose control decreased mortality. Despite the faults of this trial, it created a movement for strict glucose goals of around 120 mg/dL.

 However, the subsequent NICE‐SUGAR trial, targeting a glucose level less than 180 mg/dL, showed decreased mortality and less hypoglycemia compared with intensive glucose control. Despite the contradicting evidence, the consensus at this time is to target a glucose level of 140–180 mg/dL.

 There is no universally accepted insulin regimen for glycemic control in critically ill patients. However, to avoid prolonged hypoglycemia, which may be harmful, insulin infusions and intermittent short‐acting insulin are typically used until the patient is stable enough to be transitioned to subcutaneous insulin.

 No oral agents are used in the ICU for glucose control given the unpredictability of the metabolism in critically ill patients.

 Depending on the glucose level, insulin can be given intravenously or subcutaneously. If there is a reading above 220 mg/dL or two consecutive readings above 180 mg/dL, the intravenous route is preferred. If the glucose reading is between 160 and 179 mg/dL, subcutaneous insulin is given. The options in subcutaneous insulin include short‐acting insulin, sliding scale insulin, NPH insulin, and long‐acting insulin.