Quote from evans_c1
yea, i guess i was kind of harsh..but it did make me mad bc I felt some of the nurses were ganging up on me or something bc I did give it. I really don't understand their raionale (yes, even if they were npo)...they kept saying "we don't want her to be in the 40's at 5am" and I felt like saying maybe the day shift nurse doesn't want the BS to be 350 at 10 am the next morning. I don't think they are analyzing the whole situation..they seem to be taking a couple bad experiences and applying it to all patients.
Yes, Lantus is a basal insulin, but it is also a 24h insulin. If the pt's BG was 87-105 NPO than why would he need the Lantus? You were very fortunate that the Lantus didn't lower your pt's BG to 40's and you'd be pushing Dextrose all night. I used to work for Aventis and specifically was on the Lantus team. It is a very effective insulin, but all insulins need to be either held or the dose possibly adjusted for an NPO patient.
Does the pt. have IDDM or non IDDM? Is he achieving target BG with Lantus alone, or is he using Lantus and coverage with another insulin such as NPH, 70/30, or oral anti-diabetics. Does the pt. have IVF infusing with or without dextrose? These are all things that the physician must consider when adjusting the dose. As nurses, we need to know when to contact the physician for dose adjustment. As we all know, the ball is often dropped when the pt's nutritional status changes. Nursing is rarely black and white.
Don't be so sure your charge nurse doesn't understand Lantus. She's probably spent a night pushing dextrose. I have and its not fun esp. for the pt. Low BG feels like sh**.
Be careful that nutritional intake matches insulin coverage. If nutrition ceases (new NPO status, interruption of feedings, etc), the insulin dose must be adjusted downward. You cannot adjust a 24-hour insulin on a stat-basis.
You must consider what your patient's insulin and nutrition status. Remember that with Lantus if you give too much, your giving too much for 24 hours. Your charge nurse was right to question the dose. The right thing to do would have been to question the ordering physician or his resident. Giving it blindly will not always work out well for your patient.