Do you ever hold Lantus?

Specialties Endocrine

Updated:   Published

My understanding is that you do not hold lantus. (I'm a new grad just started in LTC). BG WAS 126 after having dipped tp 67. I raised his glucose to 126 and administered the Lantus. I'm an RN, and the oncoming nurse was an LPN. He was irritated with the fact that I gave the Lantus. I respect LPNs experience and I do learn from them, but there is a reason why RNs are needed. That last year of nursing school, you grow and learn so much that LPNs do not get in the LTC setting. What are your thoughts on holding Lantus?

I would never say to never do something. Context and clinical judgement should always be considered, however with that said if you don't have to make that decision on your own or there is a consistent trend that the patient is getting lows, take action and get appropriate changes in place from the provider. If lantus/levemir is given and there is justification for concern of lows in the next 24 hours, make sure everyone is aware and step up monitoring etc.

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never ever hold Lantus - its onset isn't even for 1.5-2hrs!

as others have said, if you notice a pattern of lows throughout the day, or that the pt is having to eat/drink carbs when not hungry/thirsty just to stay within range (i.e. they cannot go 4 hours without eating/drinking), then yeah, look at the overall dosage... or even SPLIT the dosages if you're noticing a pattern at a specific time of day.

but never ever ever hold Lantus because of a recent low - you'll just cause later highs.

this is a very important thing to teach patients for their "sick day plans" - even if they're not eating or not keeping anything down, still give Lantus (they might even find themselves on the high side from just the stress of being sick)

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Specializes in Emergency Department.

Absent a parameter order to hold the Lantus, I would never hold that med precisely because it provides long-term coverage, long after your patient's faster-acting insulins are long since done. Now I'd be in a whole lot more careful about holding faster insulins in that situation. I'd want to keep a closer eye on the BGL for a while after bringing it back up into a more normal range. I'd be even more concerned as to why the patient had a lower BGL than was probably expected, so that might be a focus of mine after things have been dealt with.

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Specializes in CTICU.

I wouldn't order it held because of the scenario you mentioned because as others said, it's not going to affect the sugar right away, it's going to have its peak effect the next early morning. I have ordered it held if a pt will be NPO for a significant period of time and just cover with SSI.

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If my patient is going to be NPO or can't keep down food for some reason, I will hold, otherwise, give unless the patient is having constant lows, in which case I would talk to the provider about new orders, perhaps a lower dosage or split dosage.

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You were right. Never hold lantus. Remember your body needs insulin round the clock and it's a long acting insulin.

Contact the Dr for a possible change in dose.

Watch what you say about LPNs.

Thank you everyone for your comments. When I re-read my original post a whole year later now, I see that it sounded offensive to LPNs. There was a whole back story thing with him being an LPN and me being an RN where when I told him I administered the lantus, he said to me I shouldn't have administered the lantus and that " new grad RNs come in thinking they know it all." I truly have utmost respect for LPNs. They do the same thing in LTC minus some IVs and get paid less. Not really fair. We happened to need more RNs because out of 180 residents, I was the only RN in the building one night and had to give IV antibiotics to 5 residents who were not mine. It took away sooo much time from my 30 skilled residents that I got very behind. I needed another RN on duty to help. I definitely did not word my original post about LPNs in the way I really think of them. I miss communicated, leaving out the story behind it, and I apologize

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That could have just as easily been an RN who was upset about you giving the Lantus. There is no need to turn this into an LPN vs. RN issue. LPN's are taught about insulin in school also. This one just happened to be wrong. It dosn't have anything to do with being an LPN.

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That could have just as easily been an RN who was upset about you giving the Lantus. There is no need to turn this into an LPN vs. RN issue. LPN's are taught about insulin in school also. This one just happened to be wrong. It dosn't have anything to do with being an LPN.

I didn't mean it that way. He had an issue with me being a new RN disagreeing with his many years LPN experience. It was HIS complex. And yes, at my current facility, there are RNs who hold lantus. Drives me nuts. Every type of nurse needs re educating on this. It was an RN LPN issue because LPNs at that specific facility resented RNs. I'm very thankful that in my current facility both RNs and LPNs respect one another mutually.

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It dosn't have anything to do with being an LPN.

HE made it an RN LPN issue because of his statement about me being an RN and him being an LPN.

End discussion. This was over a year ago, and it is a time in my life I'm trying to forget. I ended up quitting because of the resentment and major bullying I faced due to being an RN. I became suicidal, but moved on and am at a facility where title is a non issue.

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Funny- I thought physicians decided (by way of orders) what meds to give, and when, and when not. I must be missing something.

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\ said:

Funny- I thought physicians decided (by way of orders) what meds to give and when, and when not. I must be missing something.

EXACTLY. It drives me nuts when nurses hold lantus instead of taking the time to notify the MD that the patient's BG drops in morning. The prescribers need to know this so they can adjust their treatment plan.

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Specializes in ICU, CM, Geriatrics, Management.
SleeepyRN said:
I didn't mean it that way. He had an issue with me being a new RN disagreeing with his many years LPN experience. It was HIS complex...

Agree with ya, Sleepy.

Seems to me another poster was the one making this a more controversial issue.

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