should we hold the insulin or not

There should be a specific doctor's order regarding insulin while a pt is NPO for a procedure. If there isn't one, you should call the physician.

Follow Doctor's orders if anything.

But let's think about the scenarios you have given in regards to insulin.

1. You need to give insulin to a patient who is under hospitalization (stress) and illnesses which is true. The body need's energy to help itself. The same with pregnant woman who are diabetic. They are most likely to be told to increase their insulin later because their body will demand it because of the additional growth of a fetus in the woman.

2. In regards to the surgery. Think about the peak and duration of the insulin. Did it mention what time the patient's surgery was? Depending on the time and his usual medication given, it may make sense to hold it because the patient can go hypoglycemic after the peak which is dangerous for surgery if they are under sedation and anesthesia aka possibly respiratory depression.

READ THE SCENARIO.

The rationales are based on those.

Not everything will be set in stone such as performing CPR when there is no pulse.

If all patients were the same, it would be an easy world to take care of people.

I hope this makes sense!

We usually get specific orders for medications when having procedures and patient is NPO. They usually tell you which meds to give and hold.