Insulin Administration

[Sunnysidegirl]

I am a fairly new nurse and have a Question regarding the proper administration of Glargine.If a patient has 10-20 units of glargine ordered as a sheduled HS med.,the patient is not eating well,but is getting D5 in IVF,Blood sugar is below 140 but above 120,should the Glargine be held?How low should the Blood sugar be to justify holding Glargine? I realize this insulin has no peak and it is long acting... I just want to make sure I know when to hold it. Thanks!

[classicdame, MSN, EdD]

The body needs insulin 24/7, eating or not. I would not hold the Lantus for any reason other than MD order. There are other things that create hyperglycemia besides food - and the BS you report shows that hyperglycemia is still present. Even NPO patients get Lantus prior to procedures. If BS is below 70, and patient IS eating, then give snack (preferably carb + protein). If not eating - continue to monitor and notify MD if change in condition occurs. Remember, insulin is still needed even if food is not present. Dosing adjustments for basal insulin is 2-3 units every few DAYS, not hours.

[Sunnysidegirl]

The body needs insulin 24/7, eating or not. I would not hold the Lantus for any reason other than MD order. There are other things that create hyperglycemia besides food - and the BS you report shows that hyperglycemia is still present. Even NPO patients get Lantus prior to procedures. If BS is below 70, and patient IS eating, then give snack (preferably carb + protein). If not eating - continue to monitor and notify MD if change in condition occurs. Remember, insulin is still needed even if food is not present. Dosing adjustments for basal insulin is 2-3 units every few DAYS, not hours.

Thanks for your response,that makes alot of sense!

[Grow_a_Soul]

Its a long acting insulin so you wouldnt want to hold it completely even if the patient were fasting. The only time you would hold it is if the BG was consistently below normal. And you would only hold it until you had an order to decrease the dose.

[I<3H2O, BSN, RN]

I've always been instructed to never hold Lantus or Levemir (which is what we use at our facility) unless cleared with a doctor.

[classicdame, MSN, EdD]

I agree with Scoutleader. However, if you have observed hyPO events you need to talk to MD. Same as you would for HTN or any other med. If the desired effect is not there, someone needs to bring it to the attention of the MD.