From the Guidelines
Lantus (insulin glargine) should generally not be held for NPO patients with morning procedures, but rather administered at 75-80% of the usual dose, as recommended by the most recent guidelines 1. This approach is based on the principle that long-acting basal insulins like Lantus are essential for maintaining baseline blood glucose control and should not be withheld, even in the absence of food intake. Holding Lantus can lead to hyperglycemia and metabolic decompensation, which may complicate the procedure and recovery. However, it's crucial to monitor blood glucose levels before, during, and after the procedure, as hypoglycemia is still a risk in the absence of food intake. Some key considerations for managing diabetes in the hospital setting include:
- Targeting a blood glucose range of 100–180 mg/dL (5.6–10.0 mmol/L) in the perioperative period 1
- Performing a preoperative risk assessment for patients with diabetes who are at high risk for ischemic heart disease and those with autonomic neuropathy or renal failure 1
- Withholding metformin and other oral glucose-lowering agents on the day of surgery or procedure, while administering 75-80% of the usual dose of long-acting analog insulin or adjusting insulin pump basal rates based on clinical judgment 1
- Monitoring blood glucose at least every 2–4 h while the patient is taking nothing by mouth and dosing with short- or rapid-acting insulin as needed 1. Patients should bring their glucose monitoring equipment to the procedure and inform the medical team about their diabetes management. Short-acting or meal-time insulins (like Humalog, Novolog, or regular insulin) should be held when NPO, as these are specifically designed to cover carbohydrate intake at meals. The most recent guidelines from 2024 1 and 2025 1 support this approach, emphasizing the importance of careful blood glucose management in the perioperative period to minimize the risk of hypoglycemia and hyperglycemia.
From the Research
NPO Patient with Morning Procedure and Lantus Administration
- The provided studies do not directly address the question of whether to hold Lantus for an NPO patient with a morning procedure who will not be eating breakfast 2, 3, 4, 5, 6.
- However, it is known that Lantus (insulin glargine) is a long-acting basal insulin that is typically administered once daily, regardless of meals 2, 4.
- The studies suggest that insulin glargine can be safely administered without regard to meals, and its effects on glucose control are not significantly impacted by meal timing 3, 5.
- Nevertheless, for an NPO patient with a morning procedure, the decision to hold Lantus should be made on a case-by-case basis, taking into account the patient's individual glucose control needs and the timing of the procedure.
- It is recommended to consult with the patient's healthcare provider to determine the best course of action for managing their diabetes during the procedure 6.
Key Considerations
- The patient's glucose control needs and the timing of the procedure should be taken into account when deciding whether to hold Lantus 3, 5.
- The healthcare provider should be consulted to determine the best course of action for managing the patient's diabetes during the procedure 6.
- The provided studies do not provide direct guidance on this specific scenario, and therefore, clinical judgment and individualized decision-making are necessary 2, 4.