Lantus insulin question

Specialties Endocrine

Published

Just wondering about the insulin Lantus.... It seems about 90% of the nurses on my unit would hold lantus if a blood glucose was ..say maybe 45? Were they not taught that Lantus is a basal insulin and you should NEVER hold it. I would give it if their glucose was 20! I was taught to never hold it and I hate to say anything bc I'm a fairly new nurse. Anyone ever heard of such a thing?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
You said that nurses can't hold drugs without an MD or parameters. That is plainly wrong--as your own care plan acknowledged. We can and must withhold drugs that are dangerous for patients--whether or not we have an advanced provider agreeing with us. Of course we tell them about it, I was never suggesting we keep it a secret. Professionals working on the same patient should all know what the other is doing.

You're correct. I apologize for the misunderstanding and appreciate the clarification, as I worded what I was thinking incorrectly.

I certainly didn't mean that we were to blindly give meds just because the doctor ordered it, or that we have to have an MD order to hold the med.

We're educated professionals with common sense for heaven's sakes. :lol2:

I meant to say, that we don't hold the meds without ultimately collaborating with the MD and letting them know we held the medication. It is wrong to hold the med and go about your business.

I think ultimately we are in agreement. BTW I wrote a paper on automony. I've been to your referenced website before. It's awesome.

Autonomy.doc

Nobody is going to go into DKA with a blood sugar of 20! Nursing is an ongoing professional service, where we monitor people over time and intervene as appropriate--hopefully not a once-per-shift service--though I know in this age of short-staffing it can often feel that way...

The common sense way to proceed is to get the patient's blood sugar back up to normal before even considering administering any insulin at all. Once it's normal, then start thinking about the patient's previous day(s) and any intervening factors that might have made her blood sugar drop. This might make you rethink the patient's insulin dose over the 24 hours instead of just blindly proceeding on with physician prescriptions regardless of what the patient really needs...

Of course you treat the hypoglycemia first. You are correct that you have to look at the factors that contributed to the episode. The doctor may want to modify the dose if there is a trend. But again I say you never withold basal insulin for a type 1. Basal insulin is required to control hepatic glucose output even when fasting.

I think ultimately we are in agreement.

Good, I'm glad.

BTW I wrote a paper on automony. I've been to your referenced website before. It's awesome.

Thank you Tweety. We work hard on it...

interesting thread. i hope that we are being the educators that our patients require when they are sent home

as for the nurse that routinely gives 2 units when has been ordered she is playing with fire and with her license...how does the nurse working the next day know what has been given..if she gives the prescribed dose of regular dose and the patient bottoms out

Just another point to consider -

Diabetics on an insulin pump can go into DKA approx 4 hours after the insulin is stopped. So say, they go in the shower and disconnect the pump and forget to put it back on, 4 hours after disconnecting and they could be in DKA, even if their BSL was 20mgdl before the shower. Insulin pumps require a different mindset to be adapted. If a client had a pump, and a BSL of 20, stopping the insulin being administered from the pump will not help raise their sugars in the short-term, but in the longer-term (when the insulin would have peaked 30min-2 hours later).

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
of course you treat the hypoglycemia first. you are correct that you have to look at the factors that contributed to the episode. the doctor may want to modify the dose if there is a trend. but again i say you never withold basal insulin for a type 1. basal insulin is required to control hepatic glucose output even when fasting.

this point is so true, and it underscores the importance of knowing whether your pt has type 1 or type 2 dm. in our hospital a few years ago, there was the case where a woman with type 1 dm had her surgery delayed 2 days by a doctor's order: npo after midnight hold all insulin. the nurse followed the doctor's order. pt's bg in a.m, was >500 so anesthesiologist cancelled surgery. same procedure was repeted that night with same results in the a.m. it took the third try for someone to let the doctor know what the problem was.

lantus insulin acts very slowly--starts about 2 hrs after injection and lasts about 24 hrs in most people. the lantus insulin can still be given safely to a person with type 2 dm who is npo. however, if it is withheld for type 2, the results are not so drastic because with type 2 there is still some indogenous insulin present.

Specializes in Family.

I have seen several problems with Lantus. The unit I used to work on often had diabetics with Lantus rx'd. It would be given at 2200 and on a good 75% of the pts, the am fsbs would be low enough to need tx. I don't trust this insulin just because the whole "no peak" idea has been disproven by a number of my pts. Of course, there were also problems with the unit itself, where hs snacks were being given at 2000, but hs fsbs's wouldn't be done until 2130-2200. Also had some poor medical support where md's wouldn't adjust dosing. If I had a pt with a low bs, yes I would hold and call. I wouldn't create a dose on my own. I do know of nurses who have, but I don't like to play with fire.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

Usually the only way Lantus will cause a.m. hypoglycemia is if the dose is too high. I had a pt the other day who was on 40 units of Lantus in the a.m. and 60 units of Lantus at night. She had no order for pre-meal insulin. So her body was using part of the Lantus to cover meals. Of course when she was unable to eat, she was low all day long. In general, if the Lantus dose is correct, the pt will have good BG control if they are NPO. If the BG is high, the dose is too low; if BG is low at any time of the day, the dose is to high. FBG is used to adjust dose.

I work on a dialysis/renal/diabetic floor. I always call the Md if the BS is at or below 100 if getting Lantus. Most of my pt's are on a sliding scale too. I have seen pt.'s go 300's to 15 with Lantus. The pt. needs to be monitored and adjusted as needed. Look at the pt and not the policy. One person gets 20 of Lantus bottoms out and the next gets 80 units (yes 80 one time.). Clarify with the pt. what the normally get at home. Most of the time it is the same. GO with your gut and always call if something is just not right. :)

Specializes in Hospital Education Coordinator.

As a nurse and diabetic I will never hold Lantus but treat the low blood sugar then notify MD

I am not yet a nurse (finished pre-reqs for program in May - starting program in January) but I've had type 1 diabetes for almost 22 years. I've been on Lantus for almost 5 years. I find that if I am lower than 70 or so in the morning and I give my Lantus (25 units) I do end up with hypoglycemia within an hour or two. If I am giving the insulin in conjunction with eating breakfast in a few minutes, I give my usual amount, but reduce the amount of Novolog I would give to cover my carbs in the meal. That way, some of the "extra" carbs help the low. I am not sure if this would help or not in a hospital setting because of the timing of giving the Lantus and/or if the patient is able to eat.

If I could not eat breakfast, then I would first start to treat the low (with juice or the carb gel), give myself 15 minutes, re-test and then give the Lantus. I'd also re-test in about an hour to see where I am at that point.

I am not sure how that 15 minute window would work in a hospital timing. And, do you all re-test patients in a certain amount of time after lows (it's been so long since I've been in the hospital for anything diabetes related, I cannot remember - last time was for the birth of my son and I was able to do my own testing then.)

Not sure if my reply is even helpful/correct, but I am interested in how all of this works in a hospital setting.......

Specializes in Geriatrics/Family Practice.

They say that Lantus is supposed to be slow acting, but I tend to disagree. I don't think it necessarily peaks, but something goes wrong somewhere. We had a resident at the my LTC facility who we would make sure that she ate her dinner well and gave a snack to before bed and by 3 or 4 am she was at 20, lethargic, and unresponsive. We initiated glucose under the tongue, and glucagon if the number did not go up. After a while her lantus was switched to am because that way we could monitor her better. We could of lost her a couple of times at night when her B/S crashed. All of us nurses came to the consensus that lantus did have a peak, whether it be some other contributing factors, but this lady proved the drug inserts wrong. There was also another one who did the same thing and her lantus had to be adjusted to. Most drugs do what they say they are supposed to do, but you figure these drugs are tested on mostly all healthy men when they do the trials before putting them on the market, and a 80+ year old lady might just metabolize or exrete these meds just a little slower or faster. Saying that babies and children are little adults is like saying the elderly are just like older adult and they can all be treated the same, NOT. If I don't make any sense it's because I've had 6 hours sleep in 2 days and I'm quite delirious.

+ Add a Comment