Cube the pumpkin: Cut the pumpkin in half, and remove any seeds and pulp. Cut the pumpkin into large pieces and remove the skin with a knife. Cut the large pieces into cubes.
Bring a pot of water to a boil, add salt, and drop the penne in. Cook until it's before al dente (about 2-3 minutes before it's done cooking, remove it from the pot and place it into the sauce – it will finish cooking in the sauce)
While the water is boiling/pasta is cooking, heat 2 tablespoon olive oil in a pan. Add the onion and sauté until onion is tender, about 3-5 minutes.
Add the sage and sautee briefly, about 30 seconds.
Add the diced pumpkin, along with some warm water (about half a ladle full), salt and pepper. Put a lid on the pan, and let the pumpkin cook until tender, about 10-15 minutes.
Once pumpkin is tender, blend up the pumpkin/onion mixture in a blender, or with an immersion blender, along with more warm water (adjust to your liking - but start with half a ladle-full and add more if necessary)
Add the sauce back to the pan, and add nutmeg and grated parmigiano. Adjust for salt and pepper.
Add the penne to the pan, and over medium heat, mix the pasta and the sauce together until pasta has absorbed most of the sauce. Add pasta water if needed.
Plate, and top with cooked pancetta (if using) and more parmigiano reggiano.