What is the glycemic target for the majority of critically ill adult patients?

• A. 180-220 mg/dL
• B. 80-110 mg/dL
• C. 140-180 mg/dL
• D. 220-240 mg/dL

Answer: (C)

Balancing glycemic control in critically ill adults requires avoiding hypoglycemia while preventing dangerous hyperglycemia. The target that most teams aim for is about 140-180 mg/dL. This range reflects evidence showing that aiming for very tight control, such as 80-110 mg/dL, increases the risk of hypoglycemia and was associated with worse outcomes in large trials like NICE-SUGAR. Very high glucose levels, such as 180-220 or 220-240 mg/dL, keep patients in a hyperglycemic range that can worsen immune dysfunction, infection risk, and overall prognosis.

In practice, insulin is used to keep glucose within the 140-180 mg/dL window, with adjustments based on nutritional intake, medications (like steroids), organ function, and the patient’s risk for hypoglycemia. This approach provides a balance between preventing the harms of both extremes while allowing for individualized care.