Last Updated 3/23/2017 | Last Reviewed 2/23/2017
Questions? Contact Inpatient Diabetes Quality Committee
Patients with type 1 DM & insulin-requiring type 2 DM must have some basal (long-acting) insulin even when NPO.
Type of Insulin Onset Peak Duration Adjustment When NPO A written/verbal order is needed to adjust insulin.
n Humalog (lispro)
1-2 hours 4-6 hours
Hold scheduled dose
Give correction insulin as ordered to cover elevated glucoses (i.e. >150 mg/dL)
Regular 30-60” 2-4 hours 6-10 hours
NPH 1-2 hours 4-8 hours 10-20 hours Take ½ of AM dose (Give entire PM or HS dose)
**If NPH is being given to cover prednisone, the full dose may be needed.
Detemir (Levemir ) 1-2 hours 8-12 hours 12-24 hours Give usual dose. Use caution for those who use basal insulin ONLY without oral agents
or insulin for meal coverage. These patients may need 20-50% less than usual dose.
Given long duration of action for degludec, convert to alternative basal insulin while
(Tresiba U-100) 1 hour 12 hours 42+ hours
(Lantus /Basaglar ) 1-2 hours Flat ~24 hours
Insulin combinations containing mixtures of intermediate-acting
and short-acting or rapid-acting insulins will have onset, peak
and duration of action similar to the individual components.
Combination insulins should not be used when NPO since the short-acting or rapid-
acting component of the combination will cause hypoglycemia.
Orders for NPH and Regular (or rapid-acting) should be obtained. Give ½ dose of NPH
and hold Regular (or rapid-acting). (Example: 30 units of 70/30 = 21 units NPH and 9
units Regular. Give 10 units NPH; hold Regular.)
Degludec U-200 (Tresiba® U-200): duration of action – 42 hours
Glargine U-300 (Toujeo®): duration of action – 36 hours
U-500: duration of action – 12 hours
NPO adjustment for concentrated insulin types vary. Diabetes/endocrine specialists
should be consulted to determine adjustment.
Given long duration of action for degludec U-200 and glargine U-300, convert to
alternative basal insulin while hospitalized.
Oral Agents and Non-Insulin Injectables Hold all oral agents and non-insulin injectables(Orders are required)
Medication Class/ Examples
Biguanides (metformin): consider re-checking SCr post-procedure if patient has received contrast AND has history of renal disease.
Sulfonylureas (glipizide, glyburide, glimepiride)
Meglitinides (repaglinide, nateglinide)
Thiazolidinediones (“TZDs” – i.e., pioglitazone, rosiglitazone)
DPP-4 inhibitors (“gliptins” – i.e., sitagliptin, saxagliptin, linagliptin, alogliptin)
GLP-1 agonists (i.e., exenatide, liraglutide, albiglutide, dulaglutide)
SGLT-2 Inhibitors (“flozins” – i.e., canagliflozin, dapagliflozin, empagliflozin)
Medication Adjustment for Hospitalized Patients who are NPO
Association AD. Professional Practice
Committee for the Standards of Medical Care
in Diabetes-2017. Diabetes Care. Jan 2017;40