Lantus

#1 and #2 are correct. Why is the patient getting Lantus BID? Also, was she given sliding scale insulin? It's possible that she may have had too large a dose but we need more info please.

#1 and #2 are correct. Why is the patient getting Lantus BID? Also, was she given sliding scale insulin? It's possible that she may have had too large a dose but we need more info please.

I work on an endo floor. It is not uncommon to see pt's prescribed Levimir or Lantus with breakfast and bedtime. Pt may have still needed a dose adjustment though.

Lantus patients getting it at HS should definitley have a good HS snack, especially if they had SSI at supper. Lantus often needs a lot of tweaking to get the dose right in my experience, and 35 units sounds like too much (on top of SSI if the patient had that as well like other posters said) for a BS of 319. Most diabetics I see would be better off without any SSI at HS since they have plenty of time to drop before breakfast without bottoming out. During the day it's easier to keep their sugars under control; you can see their hypoglycemic reaction easier. At night, they may sleep through it with serious consequences if the nurse isn't aware.

Yes, some of the clients in this facility get large doses of insulin 70/30 bid, but the one person I am thinking of is severely overweight and can apparently handle the insulin.

This client is about 150 lbs and has fingersticks that can be as high as 548, so I guess that is why he changed her insulin order. She has no sliding scale!! What determines whether a MD orders a sliding scale or not, it seems better than ordering massive BID orders of insulin!!!

In the description of Lantus, I have read that (1) It can be given irregardless of food intake and (2) It works over a 24 hour period. I just had a client go into a diabetic coma because of administration of Lantus. The client had a fingerstick of 319 and was given 35 units of Lantus as order. This was in the am, so the client had eaten a breakfast of pancakes. Four hours later the client was found in bed difficult to arouse and the nurse working at that time had the sense to take a fingerstick, it was 20!!!! The client is also supposed to have 25 units in the pm. I have had this experience before with clients who had large doses of Lantus ordered. Has anyone else had this experience? Is this an indication of some health problem the client has?

That's not a diabetic coma...

Anyway, I don't consider 35 units to be a high dose of lantus. Sounds more like the SSI was the culprit here..

I've never seen that happen with *JUST* Lantus. What else was going on here? PT? Any sort of physical activity? Sliding scale?

DH took over 50units, and I've had pts. on 90. I'm not a fan of lantus, at least not for everyone and it seems to be the most popular long-acting insulin prescribed. It just didn't work for my husband, he needed the pump.

I have seen the 3 AM crash with Lantus often (with an HS snack and without any HS ss coverage). It used to specifically be written on our order sets NOT to hold the Lantus for NPO status!!! The diabetic nurses would get bolistic if nursing held it. I understand that Lantus is basal insulin and is supposed to produce a steady rate without the peaks and valleys. But... it is still insulin and patient needs vary depending on their situation and state. In critical care, they are constantly changing. Sometimes they are eating or on tube feeds which is abuptly stopped, they become septic or start TPN which is sometimes abrubptlystopped (although not appropriately), they start corticosteroids or wean them. I personally do not think Lantus is a good choice for a critical care patient. I believe an IV insulin drip then SS coverage is the appropriate thing until the patient is more stable and his nutrition intake is more stable and predictable and we then know where to start with the Lantus based on his insulin needs over a 24 hour period when all above mentioned aspects are stable and consistant. Back in my early days, hypoglycemia was more a priority than hyperglycemia. While I do understand the importance of tight control and the complications that we now know occur after years of high swings and poor contro,lI have received patients with lethal low blood sugars who ended up with brain damage, so I still think that hypoglycemia should be the priority. Luckily in ICU I can catch the 3AM dips, but the M/S floor do not have the luxury of taking unordered accuchecks because they have a "feeling".