gut reaction

Nurses General Nursing

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Dr. writes order "lantus 7 units at 8pm. Hold Lantus if blood glucose les than 100 at 8pm." Dr. then changes order a few days later to "Lantus 5 units at 8pm."

........would you interpret that with the new order, the 5 units should be held if gluc less than 100? or would that only go with the 7 units order?

IMO, the md should have rewritten "hold if less than blood sugar less than 100" if he wanted that criteria to continue with the new order for the 5 units.

What's your gut reaction?

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Lantus should not be held based on blood sugar. Maybe he figured that out.

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Specializes in Pediatric/Adolescent, Med-Surg.
Lantus should not be held based on blood sugar. Maybe he figured that out.

That's exactly what I was thinking. Why on earth would you hold Lantus?! Hold Lispro or Regular maybe, never Lantus. This pt will be sky high come afternoon if you hold the bedtime Lantus. Also, if the pt tends to have low blood sugars lately (ie around 100) then maybe the pt did need their dose of Lantus decreased to the 5 Units.

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Specializes in School Nursing, Pedi., Critical Care.

The new order does not state to hold if BS is less than 100. It only states what it states. The new order voids out the old order. If he wanted it held he should have written that in the new order.

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Specializes in ICU, Telemetry.

I've got a question....when you have a patient like I had a couple of days ago, DMII, and the FSBS have been running in the 80's for the prior 2 days, and then went into the 30's (requiring D50) for the 1600 stick, you still shouldn't hold the Lantus? I did, because the pt was oriented to name only, I didn't think she was really capable of realizing her sugar was low and calling for help, and I didn't want to bottom her out in the middle of the night. Her 2100 stick was 102, so I held the lantus, and her 0700 stick was 89.

Have I been looking at this wrong? I know lantus can last from 18-24 hours, but I don't think this little tiny lady was eating as much as dayshift was charting....

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nerdtonurse, I think you did the right thing holding the Lantus. That being said, I would have called the endocrinologist at the same time. They are usually prickly about nurses holding stuff without letting them know.

Even though Lantus is really a baseline maintenance insulin, a baseline of 80 dropping to 30s, with a FBS of 75-85 might be a little overkill. At least, the endocrinologist needs to know. You give the Lantus, you have to check accuchecks all during this poor ladies night. Tacky. Better to talk to endocrin.

I've never known endo docs to mind being called about this kind of stuff. They have always responded appropriately in my experience. Sometimes, in this kind of case, they leave you with pretty decent 'if this, then that' orders. Orders with some parameters.

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Specializes in LTC, Disease Management, smoking Cessati.
Dr. writes order "lantus 7 units at 8pm. Hold Lantus if blood glucose les than 100 at 8pm." Dr. then changes order a few days later to "Lantus 5 units at 8pm."

........would you interpret that with the new order, the 5 units should be held if gluc less than 100? or would that only go with the 7 units order?

IMO, the md should have rewritten "hold if less than blood sugar less than 100" if he wanted that criteria to continue with the new order for the 5 units.

What's your gut reaction?

My gut reaction is to call the physician who wrote the order to clarify! I would never assume.

Mydnightnurse :specs:

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I've got a question....when you have a patient like I had a couple of days ago, DMII, and the FSBS have been running in the 80's for the prior 2 days, and then went into the 30's (requiring D50) for the 1600 stick, you still shouldn't hold the Lantus? I did, because the pt was oriented to name only, I didn't think she was really capable of realizing her sugar was low and calling for help, and I didn't want to bottom her out in the middle of the night. Her 2100 stick was 102, so I held the lantus, and her 0700 stick was 89.

Have I been looking at this wrong? I know lantus can last from 18-24 hours, but I don't think this little tiny lady was eating as much as dayshift was charting....

You need to report the low to the endo. The Lantus might need to be adjusted, but it's not a good idea to hold it completely, unless they were on very, very little to begin with. It's not the Lantus that causes sudden lows, it's either too much short/rapid acting insulin or too little food. The pt will be very high the next day without it any Lantus.

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Specializes in Hospital Education Coordinator.

the last order written supercedes previous orders. If he did not set any parameters then just give it. I agree that Lantus should not be given per glucose level. Also, 5 or even 7 units is way low. The average national dose is 45-60 units/day.

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the last order written supercedes previous orders. If he did not set any parameters then just give it. I agree that Lantus should not be given per glucose level. Also, 5 or even 7 units is way low. The average national dose is 45-60 units/day.

The dose depends on type of diabetes, body weight, and previous response. 5-7 units could be appropriate in Type 2.

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