Current evidence supports avoiding iatrogenic factors that aggravate hyperglycemia, such as early-PN and liberal corticosteroid use, and does not support TGC, except with accurate tools and protocols that prevent iatrogenic hypoglycemia.

Any protocol for glucose control in ICU requires frequent and accurate measurements, which becomes particularly important with tighter targets. Regular potassium monitoring is also necessary to prevent insulin-induced hypokalemia.

Although (near-)continuous glucose monitoring could reduce glucose variability, routine in-ICU use is off-label, and subcutaneous sensors lack accuracy for hemodynamically unstable patients.

Short-acting insulin is currently the preferred glucose-lowering drug in ICU.

Theoretically, other drugs could be superior because insulin suppresses cellular repair processes that are important in critical illness.

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