[CarVsTree]

The BG's you are siting are critically low and I would definitely call the MD before giving.

But, I also agree that you need to see where the trends are. Is the patient eating? If the patient is not eating than giving basal insulin is not indicated.

Lantus is a great insulin, but when you give it you are stuck with it for 24 hours. I had an incident where an endocrinologist decided to switch a pt. from Lantus to 75/25. I gave lantus at hs. The next day the order for 75/25 was put in and was given. The lantus remained in the patients system for the next 12 hours along with the 75/25. Oh, did I mention that the patient also had no appetite so he was not eating. The day shift nurse that gave the 75/25 did not catch the error that the doc made so the patient now had both insulins acting simultaneously on a pt. that was not eating. The day shift nurse had to give Dextrose once or twice. I had the patient again on the following night shift and had to give Dextrose three more times. That's how long this mess had thrown his system off.

So, I don't care what the drug is I do not give it blindly. Before giving any kind of insulin Lantus or not. I want to know why the blood sugar is 45 or 20. Giving Lantus to a pt. with a BS that low could make a bad situation much worse and worse for the next 24 hours.

[onconurseRT]

Originally Posted by suemom2kay

The BG's you are siting are critically low and I would definitely call the MD before giving.

But, I also agree that you need to see where the trends are. Is the patient eating? If the patient is not eating than giving basal insulin is not indicated.

Lantus is a great insulin, but when you give it you are stuck with it for 24 hours. I had an incident where an endocrinologist decided to switch a pt. from Lantus to 75/25. I gave lantus at hs. The next day the order for 75/25 was put in and was given. The lantus remained in the patients system for the next 12 hours along with the 75/25. Oh, did I mention that the patient also had no appetite so he was not eating. The day shift nurse that gave the 75/25 did not catch the error that the doc made so the patient now had both insulins acting simultaneously on a pt. that was not eating. The day shift nurse had to give Dextrose once or twice. I had the patient again on the following night shift and had to give Dextrose three more times. That's how long this mess had thrown his system off.

So, I don't care what the drug is I do not give it blindly. Before giving any kind of insulin Lantus or not. I want to know why the blood sugar is 45 or 20. Giving Lantus to a pt. with a BS that low could make a bad situation much worse and worse for the next 24 hours.

Yeah.. As a nurse, I would need a lot of "other MD orders" to occur prior to even starting to think about giving Lantus to someone with a BS of 20 or even 45. I personally would see the "20" and really not be thinking about how much more insulin I could give them. I personally have had a blood sugar of 28 when I was attempting to drive home after a long shift at work with no lunch and I felt like crap and then passed out! I was not a "happy camper" for several hours after that. That low of sugar makes folks feel REALLY BAD, nauseated in which they can and do vomit, have a massive headache and my muscles ached something horrible. I was not interested in my "HS snack" or fruit juice to say the least. As a nurse, I would need to see some stabilization of that pt and their blood sugar for a few hours before I would even contemplate insulin administration and that is exactly how I would approach the conversation with the MD.

Good Luck....

[mandana]

I'm not giving lantus to someone with a BG of 45 without knowing why their BG is so low and discussing it with the MD. I've had this convo with a doc before, he insisted it be given, and I ended up pushing a lot of D5 into my patient that evening.

[Fire Wolf]

Just a thought to clarify here on holding the lantus insulin. Holding it does not mean that it will not be given. The doctor may well order for the insulin to be administered or administered in a different amount.

But I would hold it until I talk with the physician. I can go ahead and administer the insulin later, after I have talked with him or her, but if I had already given it and then called, I cannot remove the insulin that I have injected.

[jmgrn65]

Originally Posted by Fire Wolf

Just a thought to clarify here on holding the lantus insulin. Holding it does not mean that it will not be given. The doctor may well order for the insulin to be administered or administered in a different amount.

But I would hold it until I talk with the physician. I can go ahead and administer the insulin later, after I have talked with him or her, but if I had already given it and then called, I cannot remove the insulin that I have injected.

That was what I was trying to say, but unfortanely I work with some nurses that would hold it for low bs not necessarily a critical low, anyway and not inform the physcian.

[TheCommuter]

I've also worked with some old-school nurses who alter the amounts of insulin that are to be given.

A few months ago I remember this nurse with 19 years of experience stating, "10 units of Lantus seems unsafe. Hmmm.....I am only going to give 2 units of Lantus." She did not have any type of doctor's order to change the amount of insulin given.

[cardiacRN2006]

Originally Posted by TheCommuter

I've also worked with some old-school nurses who alter the amounts of insulin that are to be given.

A few months ago I remember this nurse with 19 years of experience stating, "10 units of Lantus seems unsafe. Hmmm.....I am only going to give 2 units of Lantus." She did not have any type of doctor's order to change the amount of insulin given.

I've seen that more times than I can count-with all types of insulin...

[RedSox33RN]

Lantus is a basular insulin, but in some people (myself as an example), it can absolutely cause a low, because they metabolize it more quickly than other people. I had to be taken off of it, and am doing fine on a pump for the last 5 years. If I had a glucose level that low (it would be another situation if it was in the 60's or 70's, I think), I wouldn't be putting additional insulin on it, basular insulin or otherwise. I'd treat the low and call the MD.

Like someone said, I would not give it and notify MD. It doesn't mean they won't get it at all.

I'm not an RN yet, but I know from experience that Lantus is one of those tricky insulins (aren't they all in some way though?) and know that even though it's supposed to be an HS-once-a-day no-peak basular insulin, some, like me, are getting peaks and actually are splitting the dose now and taking it bid. The diabetic journals state that some docs are doing a lot of adjusting of dosages with it.

[AA8301]

Hi I'm a nursing student and I,'m doing a case study on a pt that is diabetic and taking lantus and i was just wondering if there is a "normal dose" for this medication

[SandySummers]

Originally Posted by Tweety

Nurses are not licensed to hold drugs without an MD or parameters.

I beg to differ. We are ethically and legally bound to deliver the best possible care to our patients and advocate for them as we would if we were lying in the bed ourselves. We do not give medications just because some physician prescribes them. We give them because they would benefit the patient. We do not work for physicians. We work for our patients.

We are autonomous professionals, duty-bound to protect our patients over the objections of any physician or administrator, and are held to this standard in a court of law.

Giving any insulin to a patient with a blood sugar of 20 is a very bad idea. If the blood sugar is 20, then I question why this nurse would be in the mode of passing medications in the first place--we should be working vigorously to correct the blood sugar to a normal level before resuming medication administration duties. Once the blood sugar is repaired, we should examine how it got that way in the first place and consider whether or not the patient needs a dosage adjustment, and if so, negotiate with the physician or nurse practitioner for a more fitting dose.

Please read the code of ethics for nurses to learn more about where our duties begin and end.
http://www.nursingadvocacy.org/resea...of_ethics.html

Also consider reading our FAQ on nursing autonomy.
http://www.nursingadvocacy.org/faq/autonomy.html

Sandy Summers, RN, MSN, MPH
Executive Director
The Center for Nursing Advocacy
203 Churchwardens Rd.
Baltimore, Maryland (MD) USA 21212-2937
office 1-410-323-1100
fax 1-443-705-0260
ssummers@nursingadvocacy.org