Hyperglycemia and hypoglycemia are associated with poor clinical outcomes in hospitalized patients. Successful inpatient glycemic management should be provided early and continuously throughout hospitalization. Insulin is consistently implicated in causing preventable harm to inpatients, with heterogeneity of prescribing patterns and blood glucose targets adding to this risk. Guidelines and published methods for safe and effective glycemic control in the hospital are extensive; however, suboptimal glycemic control, unsafe medication regimens, and inadequate patient and provider education remain prevalent in several inpatient settings. This article aims to identify the common barriers to optimal glycemic control in hospitalized patients and offers applicable solutions.