[SouthernLPN2RN]

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.

[Myxel67]

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.

[confused101]

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.

[classicdame]

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

[lildan]

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.......

[kstec]

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.

[Suesquatch]

I had a resident who had become quite brittle, going hypoglycemic even after big meals and non-compliant snacks. I was holding her Lantus and we finally got the doctor to clarify his wishes specifically for her and his inx were never to hold the Lantus but hold everything else. She never went lower after Lantus.

[bklynborn]

I am looking for documentation on "never holding lantus" can anyone help me out?

[Myxel67]

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.

That nurse apparently knew nothing about Lantus. 2 units wouldn't lower the BG of a pigeon! It is absolutely imperative that we know what a drug does and how and when it works before giving it.

Lantus is usually adjusted based on the fasting BG level. If the FBG were 45, then the MD should be called for a lower dose order. A BG of 45 in the middle of the day is more likely related to the fast acting insulin (or oral DM med such as glyburide, glipizide, or Amaryl) and not eating enough. You know the Lantus dose is good if the person is NPO and the BG does not drop too low or rise too high.

Lantus should make up about 50% of the total daily insulin dose. Be suspicious of an order for 40 units of Lantus at bedtime, and 5 units of Novolog before each meal. Either the Lantus dose is too high, or the Novolog is too low.

Using regular insulin premeal (instead of Novolog, Humalog, or Apidra) increases the risk of low BG because it stays in the body longer and can overlap with the Lantus.

[canoehead]

Originally Posted by Tweety

Nurses are not licensed to hold drugs without an MD or parameters. Obviously using good common sense we don't blindly give drugs either.

Tweety- we sure do hold drugs. More often with orders and parameters, and sometimes hold and then notify the MD, but rarely we hold the drugs even when the doc is stamping their feet and snarling to give it. Darn right we hold them, and I'm proud to say I've done it. I would bet money you have too.

We hold Pitocin when ther is one long painful contraction for ten minutes and the baby's heart rate goes to 40bpm.

We hold Propofol when the doc wants it given in an exam room without anything but an O2 sat on a finger.

We hold lidocaine when all the patient is havin is PVC's and at a rate of 30.

Come on folks- lets hear it for nurses holding drugs!