Hyperglycemia during admission for acute myocardial infarction (MI) is common and associated with poor outcomes. Prior studies employed two distinct approaches to improve outcomes in patients with acute MI—one focused on glucose control, and the other on provision of glucose, insulin, and potassium. However, despite multiple large-scale studies, the benefits of glucose lowering in the setting of acute MI remain unclear. This article reviews data from observational studies and clinical trials and synthesizes this information into practical recommendations based on available evidence.