Lantus insulin question

Specialties Endocrine

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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?

I had a resident who had become quite brittle, going hypoglycemic even after big meals and non-compliant snacks. I was holding her Lantus and we finally got the doctor to clarify his wishes specifically for her and his inx were never to hold the Lantus but hold everything else. She never went lower after Lantus.

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Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG.

I am looking for documentation on "never holding lantus" can anyone help me out?

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
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.

That nurse apparently knew nothing about Lantus. 2 units wouldn't lower the BG of a pigeon! It is absolutely imperative that we know what a drug does and how and when it works before giving it.

Lantus is usually adjusted based on the fasting BG level. If the FBG were 45, then the MD should be called for a lower dose order. A BG of 45 in the middle of the day is more likely related to the fast acting insulin (or oral DM med such as glyburide, glipizide, or Amaryl) and not eating enough. You know the Lantus dose is good if the person is NPO and the BG does not drop too low or rise too high.

Lantus should make up about 50% of the total daily insulin dose. Be suspicious of an order for 40 units of Lantus at bedtime, and 5 units of Novolog before each meal. Either the Lantus dose is too high, or the Novolog is too low.

Using regular insulin premeal (instead of Novolog, Humalog, or Apidra) increases the risk of low BG because it stays in the body longer and can overlap with the Lantus.

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Specializes in ER.

Nurses are not licensed to hold drugs without an MD or parameters. Obviously using good common sense we don't blindly give drugs either.

Tweety- we sure do hold drugs. More often with orders and parameters, and sometimes hold and then notify the MD, but rarely we hold the drugs even when the doc is stamping their feet and snarling to give it. Darn right we hold them, and I'm proud to say I've done it. I would bet money you have too.

We hold Pitocin when ther is one long painful contraction for ten minutes and the baby's heart rate goes to 40bpm.

We hold Propofol when the doc wants it given in an exam room without anything but an O2 sat on a finger.

We hold lidocaine when all the patient is havin is PVC's and at a rate of 30.

Come on folks- lets hear it for nurses holding drugs!

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

When there are frequent problems with low BG values--especially in older adults, there may be kidney or liver problems which interfere with treatment. If kidneys are not functioning well, insulin stays in the body longer and may lead to hypoglycemia. When there is a problem with liver function, the liver may not be able to make, store, or release glucose effectively.

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Specializes in PNP, CDE, Integrative Pain Management.

If Lantus is given at bedtime, and the glucose is 45, Lantus should still be given. A person with type 1 DM can go into DKA when basal insulin is withheld. There are many reasons why the glucose is 45, including the patient not eating all of the last meal after rapid acting insulin was given, the last pre-meal insulin dose was calculated incorrectly, or the improper use of premeal "sliding scale" insulin instead of using an insulin to carb ratio to determine the correct dose. Check with the physician who ordered the Lantus, or the CDE who is following the patient's glucose trends so the true cause of the hypoglycemia can be determined. Simply holding bedtime Lantus is not the answer, and will cause more problems.

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Lantus is not to be held, no matter what thier Blood sugar is, it is not that it is slow or short acting it controls the sugar over the course of the day. It may need adjusting but it should NEVER be held. So you were right. It is harder for some of us older nurses to grasp that idea not to hold insulin when sugars are low. but holding the lantus will not effect it.

this post makes me feel alot better about a very similar situation that happened to me at work where the on coming day shift nurse (who is older might i add) proceeded to lecture me about why i shouldnt have given lantus to a pt who had a BS of 64 at 0600. she seemed so upset and made it seem like i was so incompitent for not holding the lantus. needless to say this bothered me forever- being a new nurse.but i could have sworn lantus was long acting and basal. this happened literally 5months ago, i an finally let it go now that i've read this. SIGH. lol

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Specializes in Hospital Education Coordinator.

As a nurse and diabetic I totally agree with FireWolf. The emphasis is on treatment of hypoglycemia FIRST, however, then inject the insulin. Changing the dose will not have an immediate effect on BS. It would be more important to assess why the BS was that low to begin with.

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I am a diabetes Educator.Lantus should not be held.Reason even if your patient is NPO the liver is still producing 50% of the body's glucose and the lantus is what is taking the gkucose into the cells.Without it the BG would climb.If you question wether to give insulin or not always call the physician.:wink2:

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Specializes in Hospice, Ortho/Neuro Rehab, camp nurse.

yes but being a Type 1 diabetic myself, (38 yrs) you do not hold Lantus insulin. It has no peak, if a person without diabetes is sick they're pancreas still produces their basal insulin. Even of they're NPO, my Doc did this to me when I was in the Hospital and my BG went up to 953, I had to sign myslef out so I would not go into DKA. I agree with calling the MD absolutely, but I would hold a short acting or maybe even NPH, but not Lantus.

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Specializes in Hospital Education Coordinator.

I would not hold but would give snack. This is what mfg. and PDR recommends.

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Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
yes but being a Type 1 diabetic myself, (38 yrs) you do not hold Lantus insulin. It has no peak, if a person without diabetes is sick they're pancreas still produces their basal insulin. Even of they're NPO, my Doc did this to me when I was in the Hospital and my BG went up to 953, I had to sign myslef out so I would not go into DKA. I agree with calling the MD absolutely, but I would hold a short acting or maybe even NPH, but not Lantus.

Many people with diabetes (including type 1) still use NPH for basal coverage. This is especially true for patients of pediatric endocrinologists. Although the NPH nsulin dose might need to be decreased, it should not be held. After treating the low BG, the most important thing is to identify the cause of the hypoglycemia and correct that, if possible.

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