Insulin while NPO?

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Silly question: would you give insulin to a patient who was NPO before surgery? It seems like the answer could be obvious, but I am feeling a little guilty. Scenario: Mr. Smith was an elderly, diabetic patient admitted at 3am for SBO on a busy night shift. BG in ER initially was 130. I wake up the groggy resident to call for admit orders, and I forget to remind her the patient is diabetic. She states he should be kept NPO for surgery in the AM. About an hour later, I realize I didn't get an order for BG AC&HS or a sliding scale. I grab a blood sugar, and it is 185. I ask my charge nurse if I should wake the resident up again for a sliding scale order, and she states he is NPO and the blood sugar wasn't that high, so I wouldn't be covering regardless. I was hoping the resident would be in early so I could still ask before I left, but they weren't so I ended up passing it on to dayshift. I feel bad now for not covering the patient.

I agree, doc has final word. Be your patients advocate though and request that at least partial dose of BASAL is given, maybe even give the whole dose depending on procedure time, insulin resistance,past blood sugars following NPO status. After all, their bodies are not making enough of it, they need their insulin!

Obviously hold pre-prandial dose since they are NPO.

Personally, I would give the sliding scale coverage as well. If you're NPO and your BG is greater than 250-your patients body will suffer high or low, and a stble bg prior to a procedure is a must!

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