Intended for healthcare professionals

Practice Essentials

Managing adults with diabetes in hospital during an acute illness

BMJ 2017; 357 doi: (Published 22 June 2017) Cite this as: BMJ 2017;357:j2551
  1. Tahseen A Chowdhury, consultant in diabetes1,
  2. Hannah Cheston, foundation year 1 doctor1,
  3. Anne Claydon, consultant nurse in diabetes1
  1. 1Department of Diabetes and Metabolism, Barts Health NHS Trust, The Royal London Hospital Whitechapel, London E1 1BB, UK
  1. Correspondence: T A Chowdhury Tahseen.Chowdhury{at}

What you need to know

  • In general, do not stop insulin treatment in a person with type 1 diabetes; if the person is used to carbohydrate counting and correction dosing, encourage them to self correct

  • Assess a person with acute hyperglycaemia as a whole, taking into account their clinical condition, previous glucose control, and factors that may be contributing to hyperglycaemia

  • Involve the diabetes specialist team if available at an early stage, especially for patients struggling with their diabetes management.

Diabetes is common and becoming commoner. Data from the UK National In-patient Diabetes Audit (NADia) suggests that around 1 in 5 inpatient beds are occupied by a person with diabetes and that diabetes can often be poorly managed in hospital, with around 1 in 10 in patients developing a severe hypoglycaemic episode and around 1 in 4 inpatient charts showing medication management errors in the preceding seven days.1 This article highlights the principles of managing adult patients in hospital with diabetes who are acutely unwell and is aimed at non-specialists.

Sources and selection criteria

We searched Pubmed, Google Scholar, CINAHL, and the Cochrane Database using the terms “management of diabetes/hyperglycaemia in hospital” and “management of diabetes during acute illness.” We reviewed guidelines from the Joint British Diabetes Societies, National Institute for Health and Clinical Excellence, European Association for the Study of Diabetes, and American Diabetes Association.

Is tight glucose control in inpatients necessary?

Poorly managed hyperglycaemia in patients who are acutely unwell can lead to adverse outcomes in terms of morbidity, mortality, and longer hospital stay.2 There is, however, no randomised trial evidence to demonstrate that tight management of glucose control in inpatients can improve outcomes, and such evidence is urgently required. Hyperglycaemia may be encountered in patients with known diabetes, patients newly presenting with diabetes, or patients with transient hyperglycaemia related to illness, medication (such as corticosteroids), or enteral feeding. Careful assessment and …

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