For patients with diabetes, a single hospitalization may involve multiple transitions. For patients with diabetes, a single hospitalization may involve multiple transitions. Each transition requires a careful approach to insulin therapy. Patients may be admitted to a ward or to the ICU or proceed directly to surgery. They may then receive different levels of care with overlapping or sequential interventions such as NPO status, enteral nutrition by tube feeding, or total parenteral nutrition (TPN); medications such as steroids that may worsen glycemic control; and dialysis. Patients transition back to an outpatient setting, either directly to their home or to an intermediate setting such as a rehabilitation or skilled-nursing facility. The clinical situation may shift frequently, with numerous opportunities for breakdowns in communication among teams and various care providers at all levels. Cecilia C. Low Wang, and Boris Draznin Diabetes Spectr 2013;26:124-130 ©2013 by American Diabetes Association