Holding insulin for NPO & surgery

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.

It depends on what kind of diabetes the patient has. You almost never withhold long-acting insulin from a person with T1 but often the dose is reduced if the patient is fasting, more frequent monitoring is done, and the patient may receive IV dextrose to prevent a hypo.

Our standard protocol is: half usual insulin, 2/24 BSL's, run 5% destrose 8-12/24 (10% 24/24 if fluid restricted) if BSL is

I asked a couple of nurses and they said to hold the insulin before the surgery since the pt is NPO...this site also mentions halfing the dose before 930..

http://www.asanr.com/common_preoperative.asp

ok. the reason i asked was because my Kaplan readiness test talked about a pt post of that was NPO and whether or not to give the regular insulin or hold it. the answer was to give the regular insulin. The kaplan instructor said you NEVER hold regular insulin

also just to add, i found this question on one of the trainers kaplan has. i am doubting that you have the rationales for the readiness test on hand because they only provide it at the center? the trainers on the other hand, has the rationales on that. and it said to HOLD the insulin. and it also said to use the sliding scale as for the regular insulin, based on the recent glucose readings.

hope this helps.

I don't know what the books say but at one of the hospitals I was at if the pt was NPO they would get 1/2 the dose of insulin.

This is what we were taught in school.