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Misunderstanding Basal Insulin Requirements Can Be Deadly

Jun 23, 2020

Basal insulin and nil per os (nothing by mouth)….

In an inpatient setting, a type 1 diabetes patient was scheduled for surgery the next morning. The patient was to be NPO after midnight and so the RN on duty withheld the patient’s Lantus. The patient’s glucose crept up, but this was not communicated with the house staff until it reached > 400, the critical level to report….


At this point the patient was in DKA and the angiogram was cancelled. The patient was admitted to the ICU for an insulin infusion. In the end, the patient did well and the surgery was rescheduled. In this case, the disaster was not averted, but it could have been prevented had the Lantus been given as prescribed.

Lessons Learned:

  • Everyone who provides care to people who have diabetes, including the patient, need to be educated on the different types of diabetes and the different types of insulin (onset of action, peak, and duration).
  • When it comes to basal-bolus insulin, people need to understand basal insulin is not meal-related. In general, basal insulin is not to be held if someone is NPO. Bolus insulin is meal-related and used to correct high glucose levels.
  • If your patient is going to be NPO, make it clear in your orders NOT to withhold the basal insulin or change the dosage as necessary.

Submitted anonymously


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