Should the patient stop their insulin?

No, the patient should absolutely NOT stop their insulin

The American Diabetes Association explicitly states that patients should be advised to never discontinue insulin and to seek professional advice early in the course of illness. 1 This is a critical safety principle that applies regardless of blood glucose readings.

Why Insulin Must Never Be Stopped

Stopping insulin is dangerous and can lead to life-threatening complications:

• Discontinuing insulin is a common precipitant of diabetic ketoacidosis (DKA), particularly in urban populations where economic barriers lead to insulin interruption 1
• Interruption or discontinuance of intravenous insulin therapy after recovery without subsequent coverage with subcutaneous insulin is one of the most common complications leading to hyperglycemia 1
• For patients with Type 1 diabetes, insulin is absolutely necessary for survival regardless of blood glucose readings 2
• Discontinuing insulin can rapidly lead to hyperglycemia and potentially diabetic ketoacidosis, which is a life-threatening condition 2

What Normal Blood Glucose Actually Means

A single normal blood glucose reading does NOT indicate insulin should be stopped:

• Insulin requirements fluctuate daily based on multiple factors including food intake, physical activity, stress, illness, and hormonal changes 2
• Normal blood glucose readings indicate that the insulin therapy is working effectively, not that it's no longer needed 2
• Self-monitoring of blood glucose should be used to adjust insulin dosage, not to determine whether insulin should be taken at all 2

Special Considerations During Illness

During illness, insulin becomes even MORE critical, not less:

• Insulin needs often increase during illness despite decreased food intake 2
• It is especially important that insulin be continued even if the patient is unable to eat or is vomiting 2
• Sick-day management should include specific information that patients should never discontinue insulin and seek professional advice early 1

The Correct Approach: Dose Adjustment, Not Discontinuation

If blood glucose is normal or low, the solution is insulin dose adjustment:

• Insulin dosing may need adjustment based on patterns of blood glucose readings over multiple days, not single readings 2
• For elderly patients, while hypoglycemia prevention is important, discontinuing insulin entirely is not the solution - dose adjustment is the appropriate approach 2
• When transitioning from intravenous to subcutaneous insulin, continue IV insulin infusion for 1-2 hours after starting subcutaneous insulin to ensure adequate plasma insulin levels 3

Common Pitfalls to Avoid

The most dangerous mistake is stopping insulin based on a single reading:

• Interruption of insulin infusion is a common cause of persistent or worsening ketoacidosis 3
• Hyperglycemia secondary to interruption/discontinuance of intravenous insulin therapy after recovery without subsequent coverage with subcutaneous insulin is a well-documented complication 1
• Medication errors involving insulin can occur at each step, and patients generally know more about the practicalities of their insulin treatment than healthcare professionals with intermittent involvement 4

Immediate Action Required

Schedule follow-up within 1-2 weeks to review blood glucose patterns and adjust insulin dosing if needed 2:

• Consider referral to diabetes education if the patient demonstrates knowledge gaps about insulin management 2
• Document the incident and education provided to ensure continuity of care 2
• Ensure the patient understands that basal insulin coverage must continue, particularly critical for type 1 diabetes patients even when not eating 3