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Initiating insulin therapy in critically ill patients with diabetes is guided by specific blood glucose thresholds to maintain safety and effective glucose control. The threshold of 180 mg/dL is recognized as a practical point to start insulin treatment in these patients, reflecting consensus from various clinical guidelines.

This level is associated with reducing the risk of hyperglycemia-related complications while promoting overall glycemic control during critical illness. Insulin therapy initiated above this threshold aims to prevent potential adverse outcomes such as increased morbidity, extended intensive care unit (ICU) stays, and higher mortality rates linked to poorly controlled blood glucose levels.

Lower thresholds, such as 150 mg/dL or values significantly lower than this, may not necessarily align with established protocols for insulin initiation, particularly in a critical care setting where maintaining appropriate blood sugar levels can be more complex due to fluctuating metabolic demands and stress responses. Additionally, starting treatment at lower thresholds may lead to unnecessary insulin use, increased risk of hypoglycemia, and patient safety concerns.

Therefore, the blood glucose threshold of 180 mg/dL reflects a balance between effective management and minimizing risks in the critically ill population with diabetes.