Comprehensive Insulin Management in the Inpatient Setting

Effective inpatient insulin management is a critical component of hospital medicine, aiming to maintain glycemic control, reduce complications, and optimize patient outcomes. This review synthesizes current recommendations and evidence-based strategies for managing insulin in the inpatient setting. It outlines insulin pharmacokinetics, dosing methodologies—including basal-bolus regimens, correction scales, and limited roles for sliding scale insulin—and considerations for special populations such as critically ill, perioperative, glucocorticoid-treated, and total parenteral nutrition (TPN) patients. The review also addresses diabetic ketoacidosis management, the impact of concurrent non-insulin medications, and practical protocols for transitioning between intravenous and subcutaneous insulin. Drawing from updated guidelines from the American Diabetes Association and recent clinical trials, this article emphasizes individualized treatment plans, interdisciplinary collaboration, and close monitoring to minimize hypoglycemia risk while achieving glycemic targets. Recommendations for adjusting insulin therapy in the context of comorbidities, medication interactions, and surgical interventions are also discussed. The goal is to provide hospital-based clinicians with a concise yet comprehensive reference to guide safe and effective inpatient insulin therapy.