I cannot remember. If a pt's BS is high before surgery, are we to still give the regular insulin (for nclex) & if NPO and high blood sugar.. do we still give the regular & hold the NPH?
Jun 27, '09
You would still give it. For one, the patient is under a lot of stress and will need it for that reason alone. And 2, the liver will still be releasing stored sugar in the blood, which requires insulin to stabilize glucose levels--it's referred to as the "basal insulin." If the insulin is held for an NPO patient, their glucose levels will still continue to rise due to the liver--which could cause hyperglycemia! I just know this, because for RN orientation at the hospital, we had a diabetic educator come in and explain in GREAT detail how diabetes and insulin work. And she said to NEVER hold Lantus (long-acting) insulin even if NPO, because of this reason. ESPECIALLY if the person is a Type I and cannot produce any insulin on their own---holding their dose could cause big problems!
Now, the bolus insulin SHOULD be held if the patient is NPO (which is ordered as "with meals," etc)...but the basal dose (Lantus) should always be given (even if the FSBS is low). The only way you would hold it is if you had a doctor's order, although I would hope the doctor would be smart enough to know it's probably best not to hold Lantus.
Simply put, the "nutritional insulin" (given corresponding to meals), is the only one that should be held if the patient is NPO.
Last edit by soonertwin87 on Jun 27, '09