Lantus insulin question

[evans_c1]

Just wondering about the insulin Lantus.... It seems about 90% of the nurses on my unit would hold lantus if a blood glucose was ..say maybe 45? Were they not taught that Lantus is a basal insulin and you should NEVER hold it. I would give it if their glucose was 20! I was taught to never hold it and I hate to say anything bc I'm a fairly new nurse. Anyone ever heard of such a thing?

[mandana]

I'm not giving lantus to someone with a BG of 45 without knowing why their BG is so low and discussing it with the MD. I've had this convo with a doc before, he insisted it be given, and I ended up pushing a lot of D5 into my patient that evening.

[Cheyenne RN,BSHS]

just a thought to clarify here on holding the lantus insulin. holding it does not mean that it will not be given. the doctor may well order for the insulin to be administered or administered in a different amount.

but i would hold it until i talk with the physician. i can go ahead and administer the insulin later, after i have talked with him or her, but if i had already given it and then called, i cannot remove the insulin that i have injected.

[jmgrn65, RN]

just a thought to clarify here on holding the lantus insulin. holding it does not mean that it will not be given. the doctor may well order for the insulin to be administered or administered in a different amount.

but i would hold it until i talk with the physician. i can go ahead and administer the insulin later, after i have talked with him or her, but if i had already given it and then called, i cannot remove the insulin that i have injected.

that was what i was trying to say, but unfortanely i work with some nurses that would hold it for low bs not necessarily a critical low, anyway and not inform the physcian.

[TheCommuter, BSN, RN]

I've also worked with some old-school nurses who alter the amounts of insulin that are to be given.

A few months ago I remember this nurse with 19 years of experience stating, "10 units of Lantus seems unsafe. Hmmm.....I am only going to give 2 units of Lantus." She did not have any type of doctor's order to change the amount of insulin given.

[cardiacRN2006, ADN, RN]

I've also worked with some old-school nurses who alter the amounts of insulin that are to be given.

A few months ago I remember this nurse with 19 years of experience stating, "10 units of Lantus seems unsafe. Hmmm.....I am only going to give 2 units of Lantus." She did not have any type of doctor's order to change the amount of insulin given.

I've seen that more times than I can count-with all types of insulin...

[RedSox33RN]

Lantus is a basular insulin, but in some people (myself as an example), it can absolutely cause a low, because they metabolize it more quickly than other people. I had to be taken off of it, and am doing fine on a pump for the last 5 years. If I had a glucose level that low (it would be another situation if it was in the 60's or 70's, I think), I wouldn't be putting additional insulin on it, basular insulin or otherwise. I'd treat the low and call the MD.

Like someone said, I would not give it and notify MD. It doesn't mean they won't get it at all.

I'm not an RN yet, but I know from experience that Lantus is one of those tricky insulins (aren't they all in some way though?) and know that even though it's supposed to be an HS-once-a-day no-peak basular insulin, some, like me, are getting peaks and actually are splitting the dose now and taking it bid. The diabetic journals state that some docs are doing a lot of adjusting of dosages with it.

[AA8301]

Hi I'm a nursing student and I,'m doing a case study on a pt that is diabetic and taking lantus and i was just wondering if there is a "normal dose" for this medication

[SandySummers]

Nurses are not licensed to hold drugs without an MD or parameters.

I beg to differ. We are ethically and legally bound to deliver the best possible care to our patients and advocate for them as we would if we were lying in the bed ourselves. We do not give medications just because some physician prescribes them. We give them because they would benefit the patient. We do not work for physicians. We work for our patients.

We are autonomous professionals, duty-bound to protect our patients over the objections of any physician or administrator, and are held to this standard in a court of law.

Giving any insulin to a patient with a blood sugar of 20 is a very bad idea. If the blood sugar is 20, then I question why this nurse would be in the mode of passing medications in the first place--we should be working vigorously to correct the blood sugar to a normal level before resuming medication administration duties. Once the blood sugar is repaired, we should examine how it got that way in the first place and consider whether or not the patient needs a dosage adjustment, and if so, negotiate with the physician or nurse practitioner for a more fitting dose.

Please read the code of ethics for nurses to learn more about where our duties begin and end.

http://www.nursingadvocacy.org/research/codes_of_ethics.html

Also consider reading our FAQ on nursing autonomy.

http://www.nursingadvocacy.org/faq/autonomy.html

Sandy Summers, RN, MSN, MPH

Executive Director

The Center for Nursing Advocacy

203 Churchwardens Rd.

Baltimore, Maryland (MD) USA 21212-2937

office 1-410-323-1100

fax [phone]

[email protected]

[nptobee]

It also depends on the type of diabetic that they are. In the type 1 diabetic, who has an absolute insulin deficiency you never want to hold basal insulin as they can go into DKA.

[Tweety, BSN, RN]

I beg to differ. We are ethically and legally bound to deliver the best possible care to our patients and advocate for them as we would if we were lying in the bed ourselves. We do not give medications just because some physician prescribes them. We give them because they would benefit the patient. We do not work for physicians. We work for our patients.

We are autonomous professionals, duty-bound to protect our patients over the objections of any physician or administrator, and are held to this standard in a court of law.

Thanks for the ethics lesson.

However, nothing in there convinced me that I am allowed to hold a medication and not notify the MD that I held it, if there are no parameters pre-written or no hospital policy pre-written.

Let me put it this way. For an accucheck of 20 I would autonomously and ethically decide to hold the insulin and not endanger the patient by giving it.

This is not where my duties stop. I am also bound by my lack of medical license to prescribe medications to notify the MD that I held the dose and obtain further instructions.

Giving any insulin to a patient with a blood sugar of 20 is a very bad idea. If the blood sugar is 20, then I question why this nurse would be in the mode of passing medications in the first place--we should be working vigorously to correct the blood sugar to a normal level before resuming medication administration duties. Once the blood sugar is repaired, we should examine how it got that way in the first place and consider whether or not the patient needs a dosage adjustment, and if so, negotiate with the physician or nurse practitioner for a more fitting dose.

You begged to differ, but essentially you were agreeing with the mode of action I proposed. Assess the situation with critical thinking first, hold the dose and collaborate with the MD (or NP, sorry didn't mention that one, old habits).

[SandySummers]

It also depends on the type of diabetic that they are. In the type 1 diabetic, who has an absolute insulin deficiency you never want to hold basal insulin as they can go into DKA.

Nobody is going to go into DKA with a blood sugar of 20! Nursing is an ongoing professional service, where we monitor people over time and intervene as appropriate--hopefully not a once-per-shift service--though I know in this age of short-staffing it can often feel that way...

The common sense way to proceed is to get the patient's blood sugar back up to normal before even considering administering any insulin at all. Once it's normal, then start thinking about the patient's previous day(s) and any intervening factors that might have made her blood sugar drop. This might make you rethink the patient's insulin dose over the 24 hours instead of just blindly proceeding on with physician prescriptions regardless of what the patient really needs...

[SandySummers]

Nurses are not licensed to hold drugs without an MD or parameters.

However, nothing in there convinced me that I am allowed to hold a medication and not notify the MD that I held it, if there are no parameters pre-written or no hospital policy pre-written.

...

I am also bound by my lack of medical license to prescribe medications to notify the MD that I held the dose and obtain further instructions.

You said that nurses can't hold drugs without an MD or parameters. That is plainly wrong--as your own care plan acknowledged. We can and must withhold drugs that are dangerous for patients--whether or not we have an advanced provider agreeing with us. Of course we tell them about it, I was never suggesting we keep it a secret. Professionals working on the same patient should all know what the other is doing.