Should I give Lantus (insulin glargine) to a patient who is NPO and has hyperglycemia?

Management of Lantus in NPO Patient with Hyperglycemia

Yes, you should administer the scheduled Lantus dose to an NPO patient with a blood glucose of 312 mg/dL.

Rationale for Continuing Basal Insulin

• Basal insulin (Lantus) should be continued even when a patient is NPO to prevent further hyperglycemia and potential metabolic decompensation 1
• For patients who are NPO or have poor oral intake, a basal plus correction insulin regimen is the preferred treatment approach rather than withholding insulin 1
• Sliding scale insulin (SSI) alone is strongly discouraged in hospitalized patients as the sole method of insulin treatment 1
• Maintaining consistent basal insulin administration is crucial for stable blood glucose control between meals and overnight 2

Management Approach

• For hyperglycemic patients who are NPO:

  • Continue the scheduled basal insulin (Lantus) 1
  • Add correction insulin as needed based on blood glucose monitoring 1
  • Monitor blood glucose every 4-6 hours 1
  • Avoid using only sliding scale insulin without basal coverage 1

• With a blood glucose of 312 mg/dL:

  • The patient is significantly hyperglycemic and requires insulin therapy 1
  • Withholding basal insulin would likely lead to worsening hyperglycemia and potential metabolic decompensation 1
  • The risk of hypoglycemia is low with basal insulin alone in this scenario 3

Special Considerations

• In perioperative settings, the recommendation is to give 75-80% of the usual dose of long-acting insulin analogs like Lantus when the patient is NPO 1
• For patients with blood glucose >300 mg/dL, insulin therapy should not be delayed 1
• Patients who are NPO and on long-acting insulin like Lantus may be at higher risk for hypoglycemia, but with a current blood glucose of 312 mg/dL, this risk is minimal 4

Monitoring After Administration

• Continue to monitor blood glucose every 4-6 hours while the patient remains NPO 1
• If the patient remains NPO and requires ongoing glycemic management:
  • Continue intravenous fluids if appropriate 1
  • Supplement with subcutaneous correction-dose insulin as needed 1
  • Consider adjusting the basal insulin dose if hyperglycemia persists 1

Avoiding Common Pitfalls

• Avoid withholding basal insulin in NPO patients, as this can lead to significant hyperglycemia and metabolic decompensation 1
• Do not rely solely on sliding scale insulin for glycemic control in hospitalized patients 1
• Remember that insulin glargine (Lantus) provides a relatively constant basal level of circulating insulin with no pronounced peak, making it suitable for continued use in NPO patients 5
• Be aware that abrupt discontinuation of insulin therapy can lead to poor glycemic control and potential complications 1