Carefully managing people with diabetes during hospitalization can reduce the risk of hyperglycemia, hypoglycemia, or glucose variability, which all lead to adverse outcomes, including death. Consult with a specialized diabetes or glucose management team when possible.

  • Institute validated order sets for management of dysglycemia in the hospital.

  • State the type of diabetes on the initial evaluation when it is known.

  • Perform an A1C test on all hospitalized people with diabetes or hyperglycemia (random blood glucose >140 mg/dL [7.8 mmol/L]) if no A1C result is available from the prior 3 months.

  • Assess diabetes self-management knowledge and behaviors on admission and provide self-management education when needed.

  • If feasible, continue use of personal continuous glucose monitoring and/or insulin pump therapy when clinically appropriate, with confirmatory point-of-care blood glucose monitoring for insulin dosing decisions and hypoglycemia assessment and treatment.

  • Initiate or intensify insulin and/or other glucose-lowering therapies for persistent hyperglycemia at a threshold of ≥180 mg/dL.

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A1C and glucose goals 

  • Elective surgery A1C goal: <8% (<64.0 mmol/L)

  • Blood glucose goal within 4 hours of surgery: 100–180 mg/dL (5.6–10.0 mmol/L)

  • CGM alone should not be used for glucose monitoring during surgery.

 
Medication adjustments 

  • Hold metformin on the day of surgery.

  • Discontinue sodium–glucose cotransporter 2 inhibitors 3–4 days before surgery.

  • Hold other oral glucose-lowering agents the morning of the surgery or procedure.

  • Consider holding glucagon-like peptide 1 receptor agonists on the day of the procedure or surgery for daily-dose agents and for at least 7 days before the procedure or surgery for once-weekly agents.

  • Individualize plan based on type of procedure or surgery.

 
Insulin therapy adjustments 

  • Give half of NPH dose or 75–80% of long-acting analog insulin dose or adjust insulin pump basal rates based on diabetes type and clinical judgment.

 
A1C and glucose goals 

  • Elective surgery A1C goal: <8% (<64.0 mmol/L)

  • Blood glucose goal within 4 hours of surgery: 100–180 mg/dL (5.6–10.0 mmol/L)

  • CGM alone should not be used for glucose monitoring during surgery.

 
Medication adjustments 

  • Hold metformin on the day of surgery.

  • Discontinue sodium–glucose cotransporter 2 inhibitors 3–4 days before surgery.

  • Hold other oral glucose-lowering agents the morning of the surgery or procedure.

  • Consider holding glucagon-like peptide 1 receptor agonists on the day of the procedure or surgery for daily-dose agents and for at least 7 days before the procedure or surgery for once-weekly agents.

  • Individualize plan based on type of procedure or surgery.

 
Insulin therapy adjustments 

  • Give half of NPH dose or 75–80% of long-acting analog insulin dose or adjust insulin pump basal rates based on diabetes type and clinical judgment.

 
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Tailor a structured discharge plan to the individual with diabetes:

  • Transmit discharge summaries to the primary care clinician as soon as possible after discharge.

  • Provide diabetes self-management education before discharge.

  • Ensure medication reconciliation and access.

  • Arrange virtual or in-person follow-up visits post-discharge:

    • » Schedule a visit with the primary care clinician, endocrinologist, or a diabetes care and education specialist within 1 month of discharge.

    • » Schedule earlier follow-up (1–2 weeks) if medications change or glucose goals are not met at discharge.

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© 2025 by the American Diabetes Association
2025
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