Lantus

[LEM1234]

OK...I am a new nurse and I have a question for all you other nurses out there. I had this elderly patient post-op who was on a clear liquid diet and eating greater than 50% of his trays, with D5.45 c 20 @ 75 thru IV. He was receiving 25 units of Lantus at night and there was no sliding scale ordered. The patient said his diabetes was controlled with Lantus alone. I gave him his Lantus per order. The next morning his blood sugar was 70 (I work nights). The oncoming nurse gave me all this crap (boy did she have an attitude) about how I should have held the Lantus and called the doc. I was always taught that we give Lantus to patients even if they are on a clear liquid diet.

My reasoning was this: he had dextrose through his fluids, he had a large cup of juice at bedtime, his sugars hadn't been low since his admission with Lantus being administered regularly, he was post-op and stressed...why would I hold it? Am I missing something here? I just need some input since I am a new nurse and thought I was missing something...HELP!

[wooh, BSN, RN]

70 is a fabulous blood sugar. Sounds like that nurse just wanted something to complain about. I'd have given the lantus.

[Midwest4me]

Why was the nurse getting all bijiggity over a BS of 70? I have a gentleman who is 20 or 24 every morning. 70 isnt that low.

Curious to know if your gentleman with the 20-24 CBG in the a.m. is alert? That's interesting....when I worked dialysis years ago I had a patient come in with 20, very lethargic of course but could speak some...which was so surprising to me as I'd assumed someone with a 20-24 would be nearly unconscious.

[cardiacmadeline, RN]

I agree with all the above posts and I would have given it also. Lantus does not peak, it is your basal insulin. Just on side note, you should never hold Lantus without a doctor's order. I have seen this a couple of times on my floor, nurses holding the Lantus based on nursing judgment and not notifying the MD.

[It'sMe, RN, BBA, MBA]

My sugar dropped to 20 one time. I got light headed, sweating profusely, dizzy and blurred vision. I was a newly diagnosed diabetic. My wife was the food nazi and had me down to probably 900 cal. We were at a craft fair. I forced her to buy me a piece of fudge. I took one bite. Within two minutes the symptoms disappeared. It was truly amazing. Within 10 minutes I was back to normal. Except I was very sleepy. Went to sleep in the car and slept the two hours home. She is a RN and now she listens to me when I tell her I am feeling funny. However, she will not fall for the "honey, my blood sugar is low, can I have a piece of that chessecake?" She wants symptoms first and she carries my glucometer when we are about or traveling. Darn.

[jschut, BSN, RN]

I agree with giving it.

Good call on your part!

[JB2007, ASN, RN]

Good answer. My only fault with any of this is that the DOCTOR should be held responsible for making a decision on giving or holding a medication. Since when did the RN becom such a decision maker? I don't want that responsibility. I now have about 12 drugs that I have to make a decision about holding or giving pre-op and then decide to hold or give them post-op. Why should I have to decide? I want the doctor to come and see their patient after surgery and write orders for what they want given. Same for pre-op. IMHO we are doing more and more for them and taking a lot of risk.

I do not think it is so much the nurse is now the long term decision maker as we are the short term decision maker. We have to use good sound nursing judgement based on our assessment to decide what is in the patient's best interest short term. Nurses have the education to make the decision to hold a med until the doctor can be updated and new orders given. I do not think it is a matter of doctors pushing decisions off on nurses it is a matter of they can not be there all the time, so they do have to count on nurses to be their eyes and ears. Then to report anything unexpected ASAP, so that proper orders can be given. It is not possible for the doctor to write orders for everything that may or may not happen. The orders would be too confusing.

[LEM1234]

Thanks everyone! It seems like I spend so much time when I'm not at work thinking about the things I did while at work, making sure it was the right thing to do...