Adequate glycemic control in critically ill adult patients is associated with improved patient-centered outcomes and is a pillar of foundational critical care management. Many dynamic and multifaceted factors impact glycemic control in the intensive care unit (ICU), which can pose challenges in the delicate balance of treating hyperglycemia while also avoiding hypoglycemia. Critical care pharmacists are uniquely positioned to systematically assess many nutrition-, medication-, and patient-specific factors day to day; initiate and adjust insulin regimens; and contribute to institutional quality improvement and safety processes. Together, these efforts culminate in a significant impact on optimizing glycemic control in critically ill patients.