Lantus

[Phillygryl, LPN]

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?

[SharonH, RN]

#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.

[VivaLasViejas, ASN, RN]

Did the patient also have sliding scale insulin? If so, how much and what kind was given? It's unusual to see someone crash like that after eating a high-carb breakfast and receiving Lantus, but if s/he's really brittle.......well, I suppose just about anything can happen.

I myself will not give Lantus if the pt's fingerstick is less than 80 at HS, but that's because I've seen too AM crashes after eight or more hours without food. And I think it's ridiculous to wake them up to eat at midnight or 3 AM just so the long-acting insulin doesn't send them into a tailspin. I've had more than one doctor get his shorts in a twist over that, but they're not the ones frantically trying to get an IV in pt with a FSBS of 16 so they can push an amp of D50.........I figure it's better in this case to ask for forgiveness than permission~

[ChristineN, BSN, RN]

#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.

[MoopleRN]

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.

[VivaLasViejas, ASN, RN]

Exactly!!

[TheCommuter, BSN, RN]

One of my nursing home residents was receiving 94 units of Lantus BID at 0630 and 1800, as well as 35 units of Novolog TID at 0630, 1130, and 1630. He was also on a high sliding scale with regular insulin AC and HS. He was also one of the most insulin-resistant people I've ever provided care for.

[VivaLasViejas, ASN, RN]

I have one almost as bad as yours, Commuter. He gets NPH once daily at noon, Lantus at 06 and 18, plus sliding scale regular @ AC & HS. His blood sugars regularly run in the 500s and above.......either that, or he's in the 20s. Sometimes he'll even be 500 at dinner and 50 at HS. Or vice-versa. Brittlest diabetic I ever saw.......it's a wonder he still has any vision, let alone both feet and all his toes.

[Phillygryl, LPN]

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!!!

[cardiacRN2006, ADN, RN]

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..

[VivaLasViejas, ASN, RN]

Nope, 35 units isn't a big dose; several of my diabetics are getting 50, 70, even 95 units of Lantus daily, or in the case of the above-metioned resident, twice daily. Of course, ANY dose that causes a pt to crash is too much!

[SunnyAndrsn]

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.