Holding insulin for NPO & surgery

  1. 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?
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    About MrsRNn2009

    Joined: Oct '07; Posts: 46; Likes: 10
    Pediatric Nurse Assistant
    Specialty: Pediatric CVICU


  3. by   shoegalRN
    I thought you would give insulin before surgery because of all the steroids they use during surgery, which would cause an increase in blood sugar. That's off the top of my head, I will have to look it up to be sure.
  4. by   NurseCubanitaRN2b
    You would hold the Insulin because they're not eating before surgery. If you give them the insulin the patient will bottom out. In nursing school an RN wanted ME to give my patient insulin before surgery even though my patient was NPO. I looked at her with disbelief. I was mortified that my patients RN (she was educated in another country) wanted me to give that insulin. I looked at my instructor and of course she told her absolutely not!. Now that's a scary thing had I not been there as a student that RN would have given that patient her insulin. So in answer to your question the answer is no.
  5. by   callenRN1507
    "although opinions differ, and little data are available to allow specifying optimal treatment goals or the best approach to perioperative management of diabetes, it is clear that surgical outcomes are improved in patients with diabetes who are maintained in good metabolic control. physicians must be cognizant of patients' preoperative control, their relative need for insulin, and any factors that may be likely to increase insulin requirements.
    when insulin requirements are in doubt, it is better to err on the side of providing rather than withholding insulin. the administration of adequate glucose in conjunction with the judicious use of insulin will prevent hypoglycemia. diabetic ketoacidosis or hyperosmolar states, which may result from inadequate dosing of insulin, are not so easily managed. the key to success of any perioperative management plan is frequent monitoring of glucose, electrolyte, and fluid levels, and acid-base status. prevention of surgical complications as a result of hyperglycemia is possible with meticulous perioperative glucose management. "
    - jennifer b. marks, m.d.

    you may want to check out other resources first before jumping into conclusions..it is possible that the previous nurse who happens to be an ien as what the op was saying advised him/her as a student to administer the insulin because this is what he/she (the ien) had experienced before...clearly there are issues regarding administering insulin preoperatively but it is quite unjust to imply that being ien's does not know what they are doing...it is also possible that the op did not mean it that way but still people need to be careful on putting their words so as not to offend others...

  6. by   callenRN1507
    btw necessary preventive measures are done if ever a client will receive an insulin prior to surgery so as to maintain the control of blood glucose like giving fluids with dextrose..
  7. by   MrsRNn2009
    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
  8. by   callenRN1507
    you sure dont without asking your doctor..i have also encountered that and my answer was to give it..
  9. by   araujojr
    Well, this is how I see it. It depends on the type of surgery the client is having. For example if they are having open heart, would you hold regular insulin?? NO The blood sugar will not drop it will increase because of the stress the body is going to be place on. Plus don't we want them to heal as quickly as possible if you don't control the blood sugar than they'll be at risk for developing an infection. In the end it depends on the policy at the hospital.
  10. by   oguesswhat
    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.
  11. by   callenRN1507
    you got it right, to add up, the only thing that they hold before are long acting insulin as far as i know but they still continue with the regular since its harder to correct problems due to hyperglycemia (e.g. DKA), than hypoglycemia during surgery..and just like what the OP mentioned, hypergly will delay the process of healing..
  12. by   msjsaw2u
    ...just remember that for NCLEX hospital, it would be by the book...oral medications should have a physicians order to withhold them depending on what the patient is taking, insulin may be adjusted or withheld if IV insulin administration during surgery is planned. But, blood glucose levels should be monitored during surgery.
  13. by   MrsRNn2009
    thanks very much everyone.
  14. by   soonertwin87
    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