 In 2001, a large prospective, randomized controlled trial from Leuven, showed that near normalization of blood glucose levels using an intensive insulin protocol improved clinical outcomes in patients admitted to a surgical intensive care area . In that study, insulin administration to maintain blood glucose levels between 80-110 mgdl, reduced ICU mortality by 34, and reduced the risk of multiorgan failure, systemic infection, incidence of acute renal failure, and the need for blood transfusions and prolonged mechanical ventilatory support. Interventional studies in the setting of acute coronary events have shown that intensive insulin therapy resulted in decreased short- and long-term mortality. Similarly, attainment of targeted glucose control in the setting of cardiac surgery is associated with reduced mortality and with a significant reduction in deep sternal wound infections. Similarly, in the setting of acute neurological illness, stroke, and head injury extensive observational and interventional studies indicates that hyperglycemia is associated with increased mortality and with diminished neurological recovery . Based in these observational and interventional studies, aggressive control of blood glucose is recommended in patients with critical illness. A recent position statement of the American Association of Clinical Endocrinologists recommended glycemic targets for hospitalized patients in the intensive care unit between 80 - 110 mgdL. 