Is it okay to give insulin to a patient who is NPO (nothing by mouth) with hyperglycemia (elevated blood glucose)?

Yes, Absolutely Give Insulin to This NPO Patient with Blood Glucose of 377 mg/dL

A basal plus correction insulin regimen is the preferred treatment for NPO patients with hyperglycemia, and withholding insulin in this situation risks dangerous metabolic decompensation. 1

Why Insulin is Essential in NPO Patients

• Basal insulin must be continued in NPO patients because discontinuing it leads to significant hyperglycemia and metabolic decompensation, even without oral intake 2
• The American Diabetes Association explicitly states that basal plus correction insulin is the preferred treatment for patients with poor oral intake or who are NPO 1
• Sliding scale insulin alone is strongly discouraged as the sole method of insulin treatment in hospitalized patients 1, 2

Specific Insulin Management for This Patient

Basal Insulin Dosing

• Administer 60-80% of the patient's usual basal insulin dose if they were previously on insulin 3, 2
• If this is a new insulin start, initiate basal insulin immediately given the severe hyperglycemia (377 mg/dL) 4
• Continue the basal insulin throughout the NPO period to prevent metabolic decompensation 2

Correction Insulin

• Add short-acting or rapid-acting correction insulin immediately for the current blood glucose of 377 mg/dL 1, 2
• Administer correction doses every 4-6 hours based on blood glucose monitoring while NPO 3, 5
• Use rapid-acting insulin (like aspart) which can be given subcutaneously or intravenously as needed 6

Monitoring Protocol

• Check blood glucose every 4-6 hours minimum while the patient remains NPO 2, 5
• Target glucose range of 100-180 mg/dL for most hospitalized patients 5, 4
• Increase monitoring frequency if hypoglycemia occurs or glucose trends downward 5

Critical Pitfalls to Avoid

• Never withhold basal insulin completely in NPO patients - this is the most common and dangerous error 2
• Do not rely solely on sliding scale (correction) insulin without basal coverage, as this reactive approach leads to poor glycemic control and metabolic instability 1, 2
• Do not assume NPO status means no insulin is needed - patients still have endogenous glucose production and insulin resistance that require management 2

Special Considerations

• If the patient develops signs of DKA (ketosis, metabolic acidosis), continue intravenous insulin and fluid replacement even while NPO 2
• Assess for triggering events that may have caused this hyperglycemia: corticosteroid use, infection, sepsis, or stress 1
• Have a hypoglycemia treatment protocol ready (15g fast-acting carbohydrate if able to take orally, or IV dextrose if truly NPO) 3
• Reassess insulin requirements daily as the clinical situation evolves 3