What is the recommended Lantus (insulin glargine) dose reduction for a Type 1 diabetic patient on 11 units going Nil Per Os (NPO)?

Lantus Dose Reduction for Type 1 Diabetic Patient Going NPO

For a Type 1 diabetic patient on 11 units of Lantus (insulin glargine) going NPO, reduce the basal insulin dose by 20-25% to approximately 8-9 units to prevent hypoglycemia while maintaining adequate glycemic control. 1

Rationale for Basal Insulin Reduction

When a Type 1 diabetic patient is NPO (nil per os/nothing by mouth), adjusting insulin dosing is critical to prevent hypoglycemia while still providing essential basal insulin coverage. The evidence supports the following approach:

• The American Diabetes Association and other guidelines recommend reducing basal insulin when patients are NPO 1
• For patients on established insulin therapy, a 20-25% reduction in the total daily insulin dose is recommended to prevent hypoglycemia in patients with poor oral intake 1
• For a patient on 11 units of Lantus, this would mean reducing to approximately 8-9 units

Implementation Guidelines

1. Administer reduced basal insulin dose:

   • Give 60-80% of the usual long-acting analog (Lantus) dose 1
   • For this patient on 11 units, administer 8-9 units

2. Blood glucose monitoring:

   • Monitor blood glucose at least every 4-6 hours while NPO 1
   • Use short-acting insulin as needed for hyperglycemia

3. Correction insulin strategy:

   • Provide correctional insulin coverage with rapid-acting insulin for hyperglycemia
   • If the patient remains NPO for multiple days, adjust the basal dose based on glucose patterns

Important Considerations

• Never discontinue basal insulin completely in Type 1 diabetes patients, even when NPO, as this can lead to diabetic ketoacidosis 1
• Sliding scale insulin alone should never be used in patients with Type 1 diabetes 1
• Lantus (insulin glargine) has a relatively constant basal level of circulating insulin with no pronounced peak, making it safer than NPH insulin when patients are NPO 2
• The reduced risk of nocturnal hypoglycemia with insulin glargine compared to NPH insulin is particularly beneficial in NPO patients 3

Special Precautions

• If the patient has renal impairment, consider a more aggressive reduction (30%) due to decreased insulin clearance
• For elderly patients, consider starting at the lower end of the reduction range
• If the patient is scheduled for surgery, monitor glucose levels more frequently as stress can increase insulin resistance

By following these guidelines, you can maintain adequate glycemic control while minimizing the risk of hypoglycemia in a Type 1 diabetic patient who is NPO.