# A hospitalized adult with type 1 diabetes is placed NPO for a procedure. For each insulin-management action, identify whether it is appropriate or needs correction.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546516&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

A hospitalized adult with type 1 diabetes is placed NPO for a procedure. For each insulin-management action, identify whether it is appropriate or needs correction.

|  | Appropriate | Needs correction |
| --- | --- | --- |
| Clarify and administer an individualized basal insulin dose as prescribed despite NPO status |  |  |
| Hold the prandial dose when no meal or nutrition is given |  |  |
| Check point-of-care glucose every 4 to 6 hours while the client is not eating |  |  |
| Replace basal insulin with correctional insulin alone |  |  |
| Use a personal CGM value without confirmatory point-of-care testing for every dosing decision |  |  |
| Hold all insulin until the procedure is completed |  |  |

## Explanation

A hospitalized person with type 1 diabetes needs basal insulin even when not eating because complete insulin omission can lead to ketosis and diabetic ketoacidosis. The prescriber may reduce or otherwise individualize the basal dose according to glucose trend, renal function, and procedure plan, but correctional insulin alone is contraindicated. Prandial insulin is withheld when no meal is consumed, while ordered correctional insulin may be used with glucose monitoring. For a client who is not eating, point-of-care glucose is generally monitored every 4 to 6 hours. A personal continuous glucose monitor can sometimes continue, but insulin-dosing and hypoglycemia decisions require confirmatory point-of-care measurements according to protocol.

## In-depth explanation

Correct Answer
Continue individualized basal coverage, withhold prandial insulin without a meal, monitor glucose, and use correction only as part of a complete regimen.

Why It Fits
Type 1 diabetes has an absolute basal insulin requirement even during fasting, whereas prandial insulin must track actual nutrition.

Clinical Picture
The NPO order changes meal-related dosing and monitoring but does not erase the need for basal insulin.

Memory Link
Type 1 plus NPO: basal stays, meal dose waits, glucose gets checked.

NCLEX Rule
Correction-only insulin is not an adequate inpatient regimen for type 1 diabetes.

Why the Alternatives Fail
Holding every insulin dose, giving prandial insulin without food, or dosing solely from an unconfirmed personal sensor increases the risk of ketoacidosis or hypoglycemia.

Sources
1ADA Standards of Care in Diabetes 2026: Hospital Care
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Medical unit
The client uses basal and mealtime insulin at home. A procedure is scheduled for 1400, and no food is permitted after midnight. The nurse reviews the medication administration record, glucose-monitoring plan, and current nutrition status with the prescriber.

## Key concepts

- **Basal insulin** — Background insulin coverage needed between meals and during fasting to suppress hepatic glucose and ketone production.
- **Prandial insulin** — Meal-related insulin intended to cover carbohydrate consumed with food or enteral nutrition.
- **Correctional insulin** — Additional insulin used to treat glucose above a defined range; it does not replace basal insulin in type 1 diabetes.

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