blood sugar question

[hollyberry678]

If a patient had an HS Bs of 74 and was given 10 units of Lantus, and appeared to be sleeping during the night with VSS, would you do a 'cautionary' BS check during the night, given her BS of 74?

[RedhairedNurse, BSN, RN]

Did this pt get a bedtime snack? If so, I probably wouldn't worry about it, if not I would recheck. Lantus is usually like getting one unit per hour is what a doctor once told me.

[mrwelter]

A snack would be vital. If you ever wonder about whether or not you should recheck during the night. Just do it. Some people will bottom out on you and others won't. It is always better to recheck than to wonder if you should, then you decide not to and then you find out later that you should have. People go to the hospital to be taken care of. Don't worry about waking them up. Do all that you can to make sure that they are safe. Always trust your instinct when it comes to things like this.

[Virgo_RN, BSN, RN]

Did this pt get a bedtime snack? If so, I probably wouldn't worry about it, if not I would recheck. Lantus is usually like getting one unit per hour is what a doctor once told me.

This. I would add that I would check the pt's trend, presuming they've been hospitalized for a couple of days. I'd check to see what their HS CBGs tend to run, whether they have received all of their scheduled doses of Lantus, and what their am CBGs look like. I would also ask the patient what they would do at home.

[nursej22, MSN, RN]

I agree in principle with getting a bs if it's ever a question but...

1) Lantus is absorbed over 24 hours so 10 units over 24 hours is less than .5 units per hour.

2) Is this a new med or dose for this patient? If they have been on this for a long time I would ask the patient if they would be concerned. When we start people on Lantus they get an hs check and a 3am check with VS to see how they tolerate it.

3) Snacks were traditionally given so that a person wouldn't bottom out in the middle of the night when their NPH or Lente peaked. Lantus doesn't normally peak so snacks are not so vital.

Of course there are a few people who take Lantus BID and get better control, but again, they usually can tell you what they need. I never seen anyone who didn't want to avoid hypoglycemia.

[Virgo_RN, BSN, RN]

Lantus is supposedly peakless, but I have seen people bottom out. Perhaps there were other factors at play, but it's made my attitude toward Lantus just a little more careful.

[blondy2061h, MSN, RN]

74 isn't really a BG I like to see people going to sleep on, even if it's their norm. I'd probably have given a 15 gram snack before the patient went to sleep, or if that wasn't done, done a check at MN or so. Checking how they've been running, like Virgo said, can provide tons of info as well.

[newbiepnp, MSN, RN, NP, CNS]

Being Type 1, but no longer on Lantus, I would agree that anything under 100 before bed is not ideal. Personally I would have taken a snack. I agree for the 3am check, as a patient I would be happy that my nurse was keeping an eye on me.