There are approximately 16 million individuals in the United States with diabetes and this number is rising exponentially. Current trends are that minority populations are disproportionately affected by this disorder. As the number of individuals with diabetes increases, especially in vulnerable populations, it is likely that the number of diabetic patients admitted to the hospital for critical illnesses will also increase. The major critical illnesses seen in patients with diabetes include diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic syndrome and severe hypoglycemia. These conditions may exist independently or in concert with other critical illnesses in patients with diabetes. This article will explore the pharmacological management of diabetes in critical illness and hospitalization, with special emphasis on current theories in managing hyperglycemia in the postmyocardial infarction patient.