Lantus

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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?

Specializes in ICU, Education.

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".

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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?

was the BS before or after breakfast, if after, how long? If after were her hands thoroughly cleaned? dont know about you, but i dont eat pancakes without syrup.....does she get a premeal novolog? if so did someone mix the two?.....good luck

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Specializes in Cardiac Telemetry, ED.

Ah, good question. Was this a postprandial fingerstick? Regardless, I agree with the others that 35 units of Lantus doesn't seem like enough to drop someone from 319 to 20 in four hours. I wonder what else was going on here?

I recently had a patient refuse his 40 units of HS Lantus because his CBG was 85. I explained all the steady-state/peakless stuff to him, but he was firm. He had been running in the mid-100s that day, and had had his Lantus the night before. Next day, he's running in the mid to high 200s.

BTW, he had an amputation incision that would not heal, requiring BID packing. Wonder why?

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Specializes in Cardiac Telemetry, ED.
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!!!

The beauty of Lantus is that it is "virtually peakless", unlike all other insulins (except Levemir). For some diabetics, once or twice daily dosing of Lantus is enough to keep those sharp peaks and valleys evened out, to where they don't need SS coverage. You don't have those outrageously high peaks that a little SS novolog isn't going to touch, and you end up with better overall control. Perhaps in this case, a dosage reduction is in order to avoid dropping too low, then the dosage tweaked until good control has been acheived.

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Specializes in Cardiac Telemetry, ED.

I'm really puzzled by this, but have to run for a class. I'll do some research when I get back and let you know if I find anything out.

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Specializes in Telemetry & Obs.

I take 60 units of Lantus nightly and SSI Humalog at each meal. My SSI STARTS at 14 units for BG over 150 and goes up to 20 units for BG up to 400.

Lantus doesn't peak and wouldn't have caused the patient to drop like that. There had to have been some other insulin involved.

Oh, and the patient that refused his Lantus because his HS BG was 85 needs to be educated!! His BG was normal because the Lantus WORKED!!

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Specializes in Cardiac Telemetry, ED.

Oh, and the patient that refused his Lantus because his HS BG was 85 needs to be educated!! His BG was normal because the Lantus WORKED!!

Exactly. Try to tell some people that, though.

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Specializes in Cardiac Telemetry, ED.

Did a little research. Onset of action for Lantus is 3-4 hours, the timeframe given in the original scenario. Also, there are some people who are hypersensitive to it, meaning that they would experience a greater than normal response. Maybe this was the case here?

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I've had patients keep a bottle of insulin in their closet, too, in case they felt like you didn't give them enough, they'd take an extra dose.

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Specializes in Oncology.
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.

Eh, he's probably not brittle, just on a crapass insulin (NPH) that not a single type 1 diabetic would be able to get any semblance of control on.

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Specializes in Telemetry & Obs.
I've had patients keep a bottle of insulin in their closet, too, in case they felt like you didn't give them enough, they'd take an extra dose.

During my last hospital stay I wasthisclosetocallinghubbytobringmyinsulin because the orders weren't right and the nurse brought me ONE unit for my BG of 156. My SSI would have called for 14 units so 1 unit wouldn't even start to touch that BG. I refused the one unit and thankfully my MD came about then and changed the order.

I would have told on myself, though :D

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