Giving Lantus insulin when patient is NPO

1styearsucks · Mar 12, 2009

Hi there. On my floor patients do not recieve lantus while npo that will seriously bottom them out. i have not been in the field long. maybe others may offer something else.

NurseyBaby'05, BSN, RN · Mar 12, 2009

If they are on fluids w/D5 and will be NPO for a short time, I'll give it. Oh, and a pretty stable diabetic. If they're brittle, no way! Then I just rely in the SS.

NurseyBaby'05, BSN, RN · Mar 12, 2009

If I have to cover them more than 2 or 3 times, then I'll get an order for a reduced dose.

redheadedvixen · Mar 12, 2009

All the docs in my part of the country (missouri and arkansas) tell us to give lantus no matter what their intake status is because it IS the basal insulin. I've given it to many an NPO patient and have never bottomed one out using just Lantus with no SS.

miko014 · Mar 12, 2009

We still give both - lantus as scheduled and SSI, but the SSI is on a q6h schedule rather than the pt's normal. If they have been running high or low, then we will adjust the lantus, but not based on just one or 2 readings. Obviously, if the BS is like 30, we're not going to give it, and if it's 500 we're going to change things. It's really a critical thinking and pt-dependant thing, but lantus won't bottom out the pt's sugar - or it shouldn't. At least, that's what they tell us where I work.

ntnu · Mar 12, 2009

it is usually safer to give half to two thirds the regularly prescribed dose after first assesing that the random blood glucose is above 200 but less than 249mg/dl.

SteffersRN87, BSN, RN · Mar 12, 2009

According to an endocrine doc at my hospital, Lantus has no "peak" so you can give it if the patient is NPO. I would definitely hold the sliding scale insulin. If they are super ski high >300, I'll give the doc a call.

Nurseboy1 · Mar 12, 2009

If they are on fluids w/D5 and will be NPO for a short time I'll give it. Oh, and a pretty stable diabetic. If they're brittle, no way! Then I just rely in the SS.[/quote']
If the patient is brittle, all the more reason not to hold their basal dose. Holding their lantus (which doesn't peak by the way) can put the "brittle" diabetic on quite the roller coaster that could take days to get back in control. One of the NPs I work with who runs the diabetes management program always tells us to NEVER hold the lantus. She even tells the type I diabetics that even if they are sick and vomiting to take their lantus, and we don't have that many problems with people getting hypoglycemic.
Lantus is meant to mimic the natural function of the body. Think about it your pancreas constantly releases small amounts of insulin 24/7 to maintain a normal blood sugar. Then when you eat and begin to digest, it releases a larger amount to bring the blood glucose back within normal. The lantus is meant to mimic that small sustained release, with your SS to return blood glucose back to normal after meals. Remember, your pancreas relases it's basal dose whether you're NPO or not.

blondy2061h, MSN, RN · Mar 12, 2009

A Lantus dose should ideally be adjusted to cover just the patient's fasting insulin needs, with meal time insulin covering their high blood sugars and insulin needs for food. Holding a Lantus dose in a type 1 diabetic will send them into DKA rapidly.

mama_d, BSN, RN · Mar 12, 2009

We routinely give Lantus to our NPO patients; if they have a borderline sugar and we don't know them well yet, I'll give the doc a call to verify and perhaps do an extra finger stick or two after reviewing with the patient whether or not they can tell if their sugars are dropping, etc.

One of the things that TOTALLY infuriates me is when our ED docs put our patient's Lantus on hold for no apparent reason. If they came in hypoglycemic, I can understand the rationale, but feel that perhaps a reduced dose and closer monitoring would be more appropriate. But they tend to hold it even on patients with BS in the 200+ range on their CMPs; if I catch it when they fax report, I'll call down to try and get it fixed.

Sorry, little rant there :)

LittleWing21, RN · Mar 12, 2009

I believe that at our hospital, we ARE supposed to give Lantus when pt is NPO (for the reasons already mentioned). Some docs get ticked when the nurse holds it for this reason. Of course, you need to use discretion if the pt is running low. And when I'm unsure, I usually ask around first.

Now that you mention it, I wish we had some better guidelines/protocols in the hospital for insulin!