Accounting for each medication given to a critically ill patient and its overall metabolic effects presents a challenge for even the most astute clinician. All too often, we focus on one problem and a medication to treat it, and forget to account for its side effects. Although stress hyperglycemia in the critically ill patient is a seemingly simple issue, Dr. Kittisupamongkol's statement reminds us how clinician perspective and choice of another medication can influence the understanding and treatment of hyperglycemia. The critical care community is currently struggling to determine the best balance for patients between hyperglycemia and hypoglycemia. I would suggest that the climate is ripe for more prospective studies that account for the medications prescribed, the total number of calories ingested, the total doses of insulin administered, as well as the blood glucose target achieved.