give lantus with food?

[cargalrn]

Hi, quick question. Man alert and oriented, attune to his blood sugars, novalog sliding scale and lantus HS and in the am. I work night shift. (Psych unit). Report vague and thru digging and antecdotal word of mouth, find out he got one amp of D5 yesterday for a CBG in the 50's, still a & 0 x 3. Order now to give for CBG below 60. This am right before 7a was 78. No novalog coverage needed. 70 units of lantus ordered and I gave it at 7:15 as ordered and charted it before I left. I got a call from the other night nurse that the oncoming staff "was livid" that I gave it, saying for this man it should be given with food. My argument is that the MD should be called if he gets low again, and have the dose reduced, not blame the nurse who gave it, and don't manipulate the timing of the med, get in touch with the MD, who is a resident on call, and get an Endo consult. Novalog should be given with first bite, but not so with Lantus. Breakfast is at 7:30 am on the dot. Man already had ice cream in front of him.

Please advise, I am soooo tired. Thanks.

[morte, LPN, LVN]

lantus is a basal insulin.....giving it was appropriate....

[nursej22, MSN, RN]

Sounds like your coworker has a knowledge deficit about Lantus, onset and peak (or lack thereof). Onset is about 1 hour, the negligible peak is about 5 hours.

http://www.medscape.com/viewarticle/426921_2

In a well-controlled patient, we will give Lantus when they are npo.

Perhaps your patient should have had his Lantus decreased, or maybe the doc wants to watch for blood sugar trends before he/she adjusts.

[classicdame, MSN, EdD]

Give Lantus even if patient is NPO, unless MD orders otherwise. It is designed to keep the average (basal) blood sugar at a lower level and does not peak so does not need to be associated with food. Here in the hospital we give it even prior to surgery to NPO patients.

Also, Lantus cannot be titrated like regular and fast acting insulins. If the target goals are not being met the MD/NP should gradually increase the dose (usually 2-3 units every 2-3 days, depending on patient). You did the right thing.

[cargalrn]

Thanks and I suffered great animosity for doing the right thing. It was an insulin drama. Pt is fine, Md wrote order that day to adm insulin as order, I was exonerated, but left a bad taste in my mouth for my coworkers who jumped on me.

[PerfectlyPlump, ADN, RN]

Sounds like shift-to-shift animosity.

How come we can't be a team, cover for each other (not cover-up),

teach and learn from each other ?