Lantus (Insulin Glargine): Scratching The Surface - page 3

by TheCommuter 15,458 Views | 26 Comments Senior Moderator

The cells of the human body require a continual stream of energy at all times in the form of glucose, and insulin is the the vehicle that allows this glucose to enter the cells. The pancreas of a healthy non-diabetic person has... Read More


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    I think I'd still feel uncomfortable giving lantus or levemir to a pt whose blood sugar was in the 50's. I get that the lantus won't have any immediate effect on his blood sugar level, but what if he doesn't eat? Won't the lantus just push it down further? And if you have a pt who is vomiting and not eating, shouldn't you hold the lantus until the situation resolves?
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    I received almost no education and I now wonder about what damage I may have done to my body because of the "education" I got. I am very disturbed but this is somewhat the norm for my area.....
  3. 1
    Quote from BrandonLPN
    I think I'd still feel uncomfortable giving lantus or levemir to a pt whose blood sugar was in the 50's. I get that the lantus won't have any immediate effect on his blood sugar level, but what if he doesn't eat? Won't the lantus just push it down further? And if you have a pt who is vomiting and not eating, shouldn't you hold the lantus until the situation resolves?
    The pancreas of the nondiabetic person who does not eat is still producing a low-level supply of basal insulin at all times. However, (s)he will not become hypoglycemic because the liver is constantly producing glucose to cover any basal insulin that is being secreted.

    The diabetic also needs this low-level supply of basal insulin. The Lantus will not push the blood glucose level down; rather, it will keep it steady, even if the patient does not eat. The liver of the diabetic patient is also producing glucose continually.

    If one of my patients has a blood glucometer reading in the 50s, I'll call the doctor prior to giving anything. For instance, if the patient usually takes 30 units of Lantus at bedtime, the doctor will usually instruct me to give 15 units tonight instead of the usual 30 units. I have never been told to hold the Lantus, even if the blood sugar is low.

    If the patient consistently tests at 50mg/dL at a certain time of day or night, we need to inform the doctor so they can initiate a permanent reduction in the dose of Lantus. Instead of 30 units nightly, the order might be changed to 20 units nightly or titrated downward until the consistent low blood glucose levels disappear.

    However, if you hold the Lantus altogether, the same patient's blood sugars may run sky high the next day, and nobody can figure out what is going on. The nurse who completely holds the Lantus has just deprived the patient of their much-needed supply of basal insulin.
    BrandonLPN likes this.
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    Ok, thanks for clarifying that. I've never held lantus, because I was told never to do so without a doctors order, unlike novolog which obviously has parameters. Now I understand better why.
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    Very informative. Thank you!
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    If the patient was in 50's the thing to do would be to give patient a snack and recheck bg in 15 minutes. give another 15 carb snack if still low. I would not give the langurs until the blood glucose was stable at least above 100mg/dl. I would also contact the MD to suggest decreasing the lantus dose. My rationale is that I don't want to have to fight the lantus while trying to get a sugar up.

    My daughter was diagnosed with type one diabetes two years ago. I have been a nurse for ten years and even still it was frightening and overwhelming. My free advice to anyone out there, is seek a good endocrinologist , and get a pediatric endo for children w diabetes. Our has a truly fantastic staff and the doc himself is one of the best in the country. We are blessed to be close to UVA.

    FYI any time you are unsure of
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    Quote from tcvnurse
    If the patient was in 50's the thing to do would be to give patient a snack and recheck bg in 15 minutes. give another 15 carb snack if still low. I would not give the langurs until the blood glucose was stable at least above 100mg/dl. I would also contact the MD to suggest decreasing the lantus dose. My rationale is that I don't want to have to fight the lantus while trying to get a sugar up.

    My daughter was diagnosed with type one diabetes two years ago. I have been a nurse for ten years and even still it was frightening and overwhelming. My free advice to anyone out there, is seek a good endocrinologist , and get a pediatric endo for children w diabetes. Our has a truly fantastic staff and the doc himself is one of the best in the country. We are blessed to be close to UVA.

    FYI any time you are unsure of
    Sigh.. I was saying that if you are unsure of the lantus dose being too much, then check a three am sugar. You will catch hypo episodes before they be one tragic, and if the patient is high, well then, you can correct them, and contact MD for further instructions.


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