Lantus insulin use

  1. 0
    Have any of you received orders to give Lantus in the AM? I noticed it's very effective when given at HS, but one MD group at my hospital orders it at 9am and these pts glucose are all over the place, either bottoming out or >400 with no explanation (stable NPO tube feeds for example) Any one else experience similar situation? The literature all says to give at HS.:uhoh21:

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  3. 11 Comments...

  4. 0
    Yes I have only seen orders for Lantus insulin in the evenings. I don't recall ever having an order for it in the am.
  5. 0
    Yes, I just had a patient being given lantus at 9am. Tube feed, NPO, bottomed out at 50 at noon, although the patient hadn't had any insulin since the morning before because of NPO status for a test. I have heard that there is a risk of early morning lows with HS lantus dosing - can't figure out this patient's problem, though.
  6. 0
    Lantus is specifically ordered to be given at hs. I would ask that physician to please speak with the drug rep or perhaps you could call and get the latest literature to present to this physician.
  7. 0
    Before I went on an insulin pump (with just Nnovolog), I was on Lantus. Started out just in the evening, but I was not getting 24 hr coverage. I am sensitive to any insulin, even as a Type 1, and only took 12U, but my endo said some people were not getting the basular coverage they needed with it, and some docs started prescribing it in the am, but were finding that then the fasting sugar was much too high. Some are even prescribing it 2x a day, which makes no sense either. I think if it's not giving 24hr coverage, then NPH or Lente should be used. A lot of my diabetic journals are saying the same thing about not getting full coverage, and people either get great results with it or terrible results. Not too much in-between.

    It is curious as to why a Dr. would prescribe in the am, knowing that there is very little left after 24 hrs, and a person would wake up with high b.s.
  8. 0
    There are certain types of patients that we give Lantus to in the AM if ordered by the doctor. The biggest patient population that we give it to is a certain nephrologists patients who are ESRF. Seems to be very effective, especially on the ones who have oliguria. I really do not know why, but it does work.
    Also, have had one or two patients who take it in the AM because they work nights.
  9. 0
    Lantus can be given at anytime of the day. But a patient needs to take it about the same time everyday of course. It use to be that Lantus was only taken at bedtime. But Aventis the Company that manufactures Lantus now say it is OK at anytime (I think this came about 6 months ago or so). Some people do not get 24 hours coverage. Lantus usually lasts between 18-24 hours. That is why some doctors may prescribe Lantus BID.

    I still prefer Lantus over NPH. Lantus usually peaks between 1-4 hours after injection and then it plateus. So the patient is less likely to get hypoglycemia. Whereas NPH you need to make sure it is mixed well and say you take it in the am and then at lunch you did not eat much you are going to crash. So usually I find that adults and children who take NPH tend to have to feed there insulin to avoid lows.

    However, Lantus is a more unstable insulin so you really do not want to recommend that a patient store Lantus in their refrigerator door, rather on a refrigerator shelf to avoid it bouncing back in forth as the door opens because it will cause the insulin to break down.

    Last edit by Purple_RN on Jun 30, '04
  10. 0
    I've seen no good results with Lantus!! Blood sugars are all over the place. Husband is a type 1 for 45 years and wouldn't even consider using it.
  11. 0
    One more thing - if a person is in the hospital it is hard to really form any opinion on whether or not Lantus is working well. Usually in the hospital a person is sick or just had surgery - so naturally our bodies are releasing stress hormones, which can counteract the insulin and make a patient's need for insulin greater. So it is really hard to keep blood sugars stable at the time. Thus making it hard to really see how Lantus or any other insulin for that matter is working - and more than likely when the patient gets back home and is no longer under a stressor like infection or surgery their insulin dose will most likely need to be lowered.

    Also the patient in the hospital would benefit from having a fast acting insulin to cover meals such as Humalog or Novolog in addition to a long acting insulin like Lantus or NPH.

    Last edit by Purple_RN on Jun 30, '04
  12. 0
    yes, a patient of mine had Lantus in the AM . Lord have mercy we are still trying to get her blood sugars in order. She was on it for about 2 months it was d/c'd about 3 weeks ago. Now she is just on a sliding scale. That is the only time every other patient has had it ordered at night..

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