Holding Levemir for an NPO patient

[julz68]

Last night I had a diabetic patient who was NPO. When I was checking his glucose and administering his meds, he asked about his Levemir. He stated that he normally takes 52 units at bedtime. I checked his orders, but all that was listed on the eMar was Novolog for correction.

I was always taught that you never hold Levemir. He was told the same thing by his PCP and he has also been an RN for 20+ years.

So, I paged the resident and asked him about it. He told me he would not order it since the pt was NPO.

I then told the pt what the resident had said. The pt was not happy, but understood with him also being an RN.

I told him I would keep a close eye on his sugars thru the night and to call me if he felt like he needed to be checked. His initial BS was 90. Thru the night I checked it 4 times and by 0630 it was 247.

I passed the info off to the day nurse and asked if she would discuss it with the physician during rounds.

Has anyone else been in this situation? Should I have been more aggressive with the resident? Am I correct that Levemir should not have been held?

[love lilacs]

We would most likely decrease the amount given, I've seen 1/2 the dose ordered for npo pt's. Or if it's held a sliding scale dose ordered.

[julz68]

\ said:

We would most likely decrease the amount given I've seen 1/2 the dose ordered for npo pt's. Or if it's held a sliding scale dose ordered.

That's what I thought maybe the resident would have done...ordering a lower dose of the Levemir. I just was always taught that you never hold Levemir or Lantus, so I was confused as to why he wanted it held...as was the patient.

[jaycee15]

I work in ltc and I have a resident who gets lantus and the order reads to hold it if not eating. I usually give it to her and give a hs snack. Her sugar is never low enough that I don't feel comfortable not giving if

[Esme12, ASN, BSN, RN]

I would have pushed the resident more.....reminded them that Levemir is a basal insulin that is ordered to meet the patients basic metabolic needs in the absence of food.....and said those words out loud....then I would have gone to my charge....then the supervisor .....gone up the food chain ......all to make sure that this was the course to be taken.