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Management of a patient with type 1 / pancreatic diabetes who is 'nil by mouth'

  • Increase the frequency of blood glucose monitoring to four times a day.
  • Check blood ketones. 
  • Proactive insulin dose-reduction to avoid hypoglycaemia (10-20%).
  • Withhold short / rapid-acting insulin. 
  • Consider changing twice daily mix insulin (e.g. Humulin® M3) to intermediate-acting (e.g. Humulin® I) at 50-70% total daily dose.

Start a variable rate intravenous insulin infusion (VRIII) if a patient with type 1 diabetes: 

  • is NBM, or
  • has no oral intake, or
  • has persistent nausea and vomiting. 

Do not forget to continue their long-acting insulin with the VRIII, e.g. Lantus®, Levemir®, Abasaglar®, Tresiba®, Semglee® see (VRIII).

 

Guideline reviewed: February 2025

Page updated: November 2025