Management of Basal Insulin in NPO Patients
Rationale for Continuing Basal Insulin
- The American Diabetes Association recommends a basal plus correction insulin regimen as the preferred treatment for noncritically ill hospitalized patients who are NPO 2
- Discontinuing basal insulin in NPO patients can lead to significant hyperglycemia and metabolic decompensation 1
- Sole use of sliding scale insulin without basal coverage is strongly discouraged in the hospital setting 2, 3
Recommended Approach
- For NPO patients, continue the scheduled basal insulin (Lantus) but consider reducing the dose to 60-80% of the usual dose 4
- Monitor blood glucose every 4-6 hours while the patient remains NPO 2
- Add correction insulin (short-acting) as needed based on blood glucose monitoring results 1
Special Considerations
- For perioperative patients, administer 60-80% of the usual dose of long-acting insulin analog (Lantus) 4
- For patients with Diabetic Ketoacidosis (DKA), once DKA is resolved, continue intravenous insulin and fluid replacement if the patient remains NPO 5, 6
- For patients on continuous enteral feedings who become NPO, continue prior basal insulin or calculate from total daily dose 4
Avoiding Common Pitfalls
- Do not withhold basal insulin (Lantus) completely when a patient is NPO, as this can lead to significant hyperglycemia 1
- Do not rely solely on sliding scale insulin for glycemic control, as this reactive approach can lead to rapid changes in blood glucose levels 3
- Do not mix insulin glargine (Lantus) with other forms of insulin due to the low pH of its diluent 8, 9