From the Guidelines
Insulin glargine should generally be continued for patients who are NPO (nil per os, or nothing by mouth). The standard recommendation is to administer the patient's usual dose of insulin glargine even during periods of fasting, though a dose reduction of 20-25% may be considered depending on the clinical situation and the patient's risk of hypoglycemia 1. Insulin glargine is a long-acting basal insulin that provides background insulin coverage for 24 hours, helping to control hepatic glucose production and maintain baseline glucose levels. Unlike mealtime insulin, which should be held when a patient is NPO, basal insulin addresses the body's continuous need for insulin independent of food intake. Completely stopping basal insulin in insulin-dependent patients can lead to diabetic ketoacidosis or significant hyperglycemia. However, blood glucose should be monitored closely during NPO status, and the insulin dose may need adjustment based on glucose readings. If hypoglycemia occurs or glucose levels trend downward, further dose reductions may be necessary. The healthcare team should reassess the insulin regimen daily while the patient remains NPO.
Some key points to consider when managing insulin glargine in NPO patients include:
- Basal insulin is preferred for non-critically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth (NPO) 1
- A basal-plus-correction insulin regimen is the preferred treatment for patients with poor oral intake or those who are receiving nothing by mouth 1
- The sole use of sliding-scale insulin in the inpatient hospital setting is strongly discouraged 1
- Insulin glargine can be continued during periods of fasting, but dose adjustments may be necessary to prevent hypoglycemia 1
It's essential to prioritize the patient's safety and adjust the insulin regimen accordingly to minimize the risk of hypoglycemia and hyperglycemia. The healthcare team should closely monitor the patient's blood glucose levels and adjust the insulin dose as needed to maintain optimal glucose control.
From the Research
Administration of Insulin Glargine to NPO Patients
- The provided studies do not directly address the administration of insulin glargine to patients who are nil per os (NPO) 2, 3, 4, 5, 6.
- However, the studies discuss the efficacy and safety of insulin glargine in various patient populations, including those with type 2 diabetes 2, 3, 6 and critically ill patients 4.
- One study mentions the importance of considering a patient's current oral intake when determining insulin dosing 5.
- There is no clear guidance on whether insulin glargine should be administered to patients who are NPO, but it is essential to consider the patient's individual needs and medical status when making this decision.
Considerations for Insulin Glargine Administration
- The patient's blood glucose levels and overall medical condition should be taken into account when deciding whether to administer insulin glargine 2, 3, 4, 5, 6.
- The risk of hypoglycemia should also be considered, particularly in patients who are NPO or have other risk factors for hypoglycemia 3, 4, 6.
- The patient's renal function and other comorbidities should also be considered when determining insulin dosing 5.