How often should blood glucose levels be checked in patients who are Nothing Per Oral (NPO)?

Blood Glucose Monitoring for NPO Patients

For patients who are NPO (nothing by mouth), blood glucose monitoring should be performed every 4-6 hours. 1

Monitoring Recommendations Based on Patient Status

Standard NPO Patients

• Blood glucose monitoring every 4-6 hours is the standard recommendation for patients who are NPO 1, 2
• This frequency is sufficient to detect significant glycemic changes while avoiding excessive monitoring that could disrupt patient care and comfort

Special Circumstances Requiring More Frequent Monitoring

• Patients on intravenous insulin: Require more frequent monitoring every 30 minutes to 2 hours 1
• Patients with diabetic ketoacidosis (DKA): Blood should be drawn every 2-4 hours for determination of serum electrolytes, glucose, and other parameters 1
• Perioperative patients: Monitor blood glucose at least every 4-6 hours while NPO 1
• High-risk patients: Those with multisystem organ failure, liver failure, or on long-acting insulin may require more vigilant monitoring 3

Monitoring Technology Considerations

Point-of-Care (POC) Meters

• POC meters are the standard method for blood glucose monitoring in hospitalized patients 1
• Be aware that POC meters have limitations, particularly with low or high hemoglobin concentrations and hypoperfusion 1
• Any glucose result that doesn't correlate with the patient's clinical status should be confirmed through conventional laboratory glucose tests 1

Continuous Glucose Monitoring (CGM)

• While CGM provides frequent measurements of interstitial glucose levels, current guidelines do not recommend routine use of CGM in hospitalized adults until more safety and efficacy data become available 1
• CGM may detect more hypoglycemic events than POC testing but has not consistently been shown to improve glucose control in inpatient settings 1

Treatment Considerations for NPO Patients

• Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment for NPO patients 1
• For patients who develop hypoglycemia, protocols should be in place for prompt treatment with 15-20g oral carbohydrates (if able to take orally) or IV glucose 2
• Automated self-adjusting subcutaneous insulin algorithms have shown promise in reducing both hypoglycemia and severe hyperglycemia in NPO patients compared to conventional insulin treatment 4

Common Pitfalls and How to Avoid Them

• Pitfall #1: Discontinuing all insulin for NPO patients

  • "Hold-the-insulin" routines are dangerous as the body still has basal insulin needs 5
  • Continue basal insulin at appropriate doses even when NPO

• Pitfall #2: Inadequate monitoring in high-risk NPO patients

  • NPO status is a risk factor for hypoglycemia, especially in patients with liver or renal disease 3, 6
  • Ensure more vigilant monitoring in these high-risk populations

• Pitfall #3: Overreliance on sliding scale insulin alone

  • Sole use of sliding scale insulin in the hospital setting is strongly discouraged 1
  • Use basal-bolus insulin regimens which have been shown to improve glycemic control and reduce hospital complications 1

By following these evidence-based recommendations for blood glucose monitoring in NPO patients, healthcare providers can optimize glycemic control while minimizing the risks of both hypo- and hyperglycemia.