Managing Insulin While NPO on Omnipod
When NPO (nothing by mouth), you should continue your basal insulin through your Omnipod but omit mealtime boluses, while maintaining correction boluses for high blood glucose levels.
Basal Insulin Management During NPO Status
When you are NPO and using an Omnipod insulin pump, proper insulin management is critical to prevent both hyperglycemia and hypoglycemia:
Continue basal insulin delivery: The American Diabetes Association strongly recommends maintaining basal insulin delivery even when NPO to prevent hyperglycemia and potential diabetic ketoacidosis 1.
Basal rate adjustment: Consider reducing your basal rate by 20-25% if you'll be NPO for an extended period, especially if you were previously using more than 0.6 units/kg/day 1, 2.
Monitor frequently: Check blood glucose every 4-6 hours while NPO to detect any trends toward hyperglycemia or hypoglycemia 2.
Bolus Insulin Management
Omit mealtime boluses: Since you are not consuming carbohydrates, do not administer your usual mealtime boluses 2, 1.
Maintain correction boluses: Continue to use correction (or "sliding scale") insulin for high blood glucose readings 2, 1.
Correction frequency: Administer correction doses every 4 hours with rapid-acting insulin or every 6 hours with regular insulin 1.
Special Considerations for Omnipod Users
When using an Omnipod insulin pump while NPO:
Pump settings: Ensure your temporary basal rate settings are appropriate for NPO status. Most patients benefit from a 20-25% reduction in basal rate 1, 3.
Site management: Continue to follow standard insulin pump protocols including changing your infusion site every 2-3 days 1.
Hypoglycemia prevention: Have a plan for treating hypoglycemia while NPO. This may include IV dextrose if in a hospital setting or glucagon if at home 1.
Evidence-Based Outcomes
Recent research supports this approach:
A 2021 study found that when using well-titrated basal-bolus insulin therapy during fasting periods, maintaining the basal insulin dose (without significant adjustment) while omitting mealtime boluses resulted in safe glycemic control 3.
Research has shown that maintaining basal insulin while NPO results in better glycemic control compared to traditional sliding-scale-only approaches 2, 1.
Potential Pitfalls
Avoid complete insulin discontinuation: Never completely stop insulin delivery, as this can lead to diabetic ketoacidosis, especially in type 1 diabetes 2, 1.
Watch for unexpected hypoglycemia: Be vigilant for hypoglycemia, especially if you've been NPO for >24 hours, as insulin sensitivity may increase 1.
Avoid over-correction: Don't administer excessive correction doses, as stacking insulin can lead to severe hypoglycemia 1.
If you're NPO in preparation for a procedure or surgery, communicate with your healthcare team about your insulin pump use, as specific protocols may vary based on the duration of NPO status and the nature of the procedure.