Question about holding Lantus

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Specializes in LTC/Skilled Care/Rehab.

Many of the nurses at the facility I work at will hold Lantus if the BS is below 100. I thought that we weren't supposed to hold Lantus unless the BS is under 60. And then you would call the MD to see if you should hold the Lantus or not. For example, would you hold Lantus for a BS of 75? I tried to look for information regarding when Lantus should be held but I couldn't find anything. Some people are on large doses of Lantus (like 80 or more). One of the drug reps came to work and said that Lantus should only be held if the BS is under 60. I don't always trust what they say ;) so I was just wondering what other nurses do. Thanks!

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Specializes in LTC, Med-Surg, GP Office.

Here's a thread with the hold Lantus discussion: https://allnurses.com/diabetes-endocrine-nursing/lantus-insulin-question-170231.html

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Specializes in Med/Surg, LTAC, Critical Care.

Lantus ain't rapid acting like the sliding scale insulins are so for a BS of say 80-100, I wouldn't be too terribly concerned, just make sure they get a bedtime snack.. I've never held Lantus, but for my patients receiving SS and Lantus, I've held the SS plenty of times, and gave the Lantus.

Of course, it all goes back to the patient history too. Find out how the patient usually reacts to that dose.

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

This still bothers me. Sorry, but as a Type 1 Diabetic for 38 years, and now a registered nurse, Lantus is not an insulin to hold, it has no peak, it is a basal insulin and works like a regular functioning pancreas. The rapid acting and short acting are the insulins I will hold. I also ask the Pt what they would do, if I am really nervous of a patient getting too low then I would ask the MD. Even if a person is NPO Lantus is not a held insulin, a diabetic can get into trouble very fast if it is. OK with that said check out your facilities policies and always call the MD if you are unsure.

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This still bothers me. Sorry, but as a Type 1 Diabetic for 38 years, and now a registered nurse, Lantus is not an insulin to hold, it has no peak, it is a basal insulin and works like a regular functioning pancreas. The rapid acting and short acting are the insulins I will hold. I also ask the Pt what they would do, if I am really nervous of a patient getting too low then I would ask the MD. Even if a person is NPO Lantus is not a held insulin, a diabetic can get into trouble very fast if it is. OK with that said check out your facilities policies and always call the MD if you are unsure.

I agree with above. Was taught in diabetic ed. cert. to not hold as it is a basal insulin. The endocrinologists do not usually want you to hold for that reason.

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I have written about this before, I had a patient that had been unhappy and had decided to not eat all day and when I checked her BS at 5 pm it was 48, she was talking and fine. I got her PBJ sandwich, and milk, and I held her scheduled 30 units of combination 70/30 insulin. Her BS was fine, it went up and THEN I charted everything I did and the great outcome.

State survey came in and read it all and we got a deficiency because the nurse does not make a decision like this with out contacting the DR.

We make many decisions, and most of them are the right ones. But the right ones we make are not the ones that get noticed.

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Specializes in LTC, Memory loss, PDN.

Mightymitern said it all. Besides, it's always better to manage with diet rather than with insulin. Another one that bugs me is being too quick to hold dig, another one with a long halflife.

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Our facility has a reminder posted everywhere. It states: You wouldn't hold the pancreas, don't hold the Lantus!!!"

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Specializes in Hospice, Ortho/Neuro Rehab, camp nurse.
Our facility has a reminder posted everywhere. It states: You wouldn't hold the pancreas, don't hold the Lantus!!!"

I LOVE that! lol

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I have a resident in a small assisted living facility and we never hold her Lantus. She gets it every morning, regardless.

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If I have a patient that has been running low and is still low, I will hold their lantus and notify the doctor. A number of our type II patients need to have their lantus adjusted while in the hospital because not only does illness impact things but their diet is much more controlled than it is at home where nobody is forcing them to be compliant. I know lantus is supposed to be based on the fbs so diet shouldn't matter but in some people it appears to make a difference anyway.

And while I know lantus isn't supposed to have a peak, we have one doctor who will often switch the time a patient gets lantus before changing the dose. They'd get it at night and their 200+ bs would be in the 30s by morning but when they got it in the morning they'd do fine all day and their blood sugar wouldn't get so high in the evenings.

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Specializes in LTC/Skilled Care/Rehab.

Thanks for all the replies! I wasn't able to respond earlier because I am too exhausted after getting off of work to get on the computer ;). I can't really ask some of the patients what they would do because many of them don't know much about their meds. I work in LTC so many are there because they aren't able to take care of themselves. I gave this patient a nutrition shake along with the Lantus because he said he didn't really eat much dinner. I have learned to trust my instincts even though some of the more experienced nurses would do something different. It seems like a lot of misconceptions are spread down from one nurse to another. If someone tells me something that doesn't seem right (and is the opposite of what I have heard in nursing school) I will do research before blindly following.

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