The presence of stress-induced hyperglycemia in critically ill patients, especially in those without evidence of antecedent diabetes, is a well established marker of poor outcomes [1–4]. Two large single center studies comparing the standard strategy of permissive hyperglycemia to use of intravenous insulin to achieve a blood glucose between 80 and 110 mg/dl (intensive insulin therapy) demonstrated overall clinical benefit with the intensive insulin therapy [5, 6]. However, more recent studies of insulin therapy in critically ill patients have yielded conflicting results [7]. In addition, a growing awareness of the potential risks of hypoglycemia, which can occur more frequently when using intravenous insulin therapy, has raised concerns over the best way to control glucose. Despite this, reverting back to allowing hyperglycemia to continue unchecked is unlikely to be the correct approach either.