Would you give Lantus without BG check?

[Prettybrowngirl]

Would you give Lantus without an order to check blood glucose levels prior to administrating whatsoever? I wouldn't and while I won't go into details on this situation, I'm curious as to what other nurses think.

[suanna]

Checking a lab value- any lab value- requires that if it is a certain number, you will do such-and-such. Since all the endo docs I work with say NEVER hold Lantus- no matter what the blood sugar- It dosen't make much sense to me to check it before "giving Lantus". It does make sense to me to check glucoses AC&HS while adjusting a patients insulin routine, or when an acute illness has disrupted thier diet/activity. These checks have nothing to do with the Lantus. Once thier glucose is stable on an established dose, I see no reason to put them through a finger stick when it will make no difference in my care. Most patients can get by with a once a day glucose check- either fasting to eval for hypoglycemia, or 1hr after thier biggest carb meal to eval for hyperglycemia.

[ceridwyn]

Lantus takes 4-6 hours to reach its peak, eating will not make any difference at all as it will already been digested and show the BGL levels before the full dose of Lantus is even effective.

Lantus is usually given nocte before bed, to deal with the dawn effect, and its effectiveness is seen in the fasting BGL which is more important, so really taking a BGL before giving it is neither here nor there, just gives the nurse something to hold on to if the client did hypo, though with Lantus if not a high dose it is not a regular thing in my experience or with my colleagues experiences. It is a basal insulin and usually in people with type 2 and elderly it is given once a day.

Personally I would take a BGL but depending were I was working, not necessarily before giving Lantus insulin, biphasic,yes, quick acting, yes. If once a day Lantus in a nursing home first thing in the morning if giving at night.

BTW- It is recommended to check BGL's 2 hours after meals, 1/24 will have them with a high BGL and not show if management of their diabetes is effective.

[ckh23, BSN, RN]

I would. Whatever number you get from your glucose check will be irrelevant in regards to your Lantus injection. The onset is anywhere from 2-4hrs, but Lantus has no pronounced peak. Lantus plateaus and remains at a constant release rate.

[traveler85]

I NEVER give any type of insulin without first checking BG. I had a brittle diabetic once that bottomed out every morning, even after receiving only Lantus (her blood sugar at HS was somewhere around 140).

[ceridwyn]

The bottom line is, take it......if someone is comfortable not taking BGL and it is not, nurses registration board, hospital or nursing home policy it is up to them, when it comes to Lantus.

[sored]

Hi There,

BG management is a complicated issue. I have read responses you have recieved and they go back and forth over it because it is complicated. Because there are so many hands in the pot, I go for holding any type of long lasting insulin when there is a short acting in place. I would choose to always check BG before giving any insulin just as I would choose to check blood pressure before giving an antihypertensive.

I think it is the only safe thing to do.

[Forever Sunshine, ASN, RN]

I don't check BS before giving Lantus because the order doesn't state to hold if BS

Usually the residents who get a dose below 20units get their sugar checked at 6am. The residents who get a high dose get their BS (with sliding scale insulin) taken at HS anyway.

[sored]

Hi,

You have to check the chart and use your best sense. If your patient is not eating, you hold the medicine and talk with the doctor. My first thought is still to give a short acting insulin that is easily reversed if necessary. It is still safer to give the short acting insulin and pass on to the next nurse your decision. They will be allerted to follow up.

I hope I have helped.

[laRN1]

I always check BG before giving any kind of insulin. Yes, it is a number but if I chart it and then the patient bottoms out, I know I have that number to back me up. And yes, I would take into account the patient's history especially the last 5 blood sugars and whether they're eating/throwing up/NPO, etc. I just think like a PP wrote, that if I do get a low number, the physician may consider cutting the lantus dose.

[vampiregirl, BSN, RN]

Another piece to this puzzle is if the patient takes any oral diabetes meds, especially if they've had any recent med changes.

[Chin up]

Of course I would, for obvious reasons. Peace!

[NamasteNurse, BSN, RN]

Many residents have Lantus ordered at hs and a blood sugar is not necessary Look up the way Lantus works. It is deposited under the skin in a bleb-type fashion, you will actually feel the little ball. It is then absorbed into the system over time. It is a very slow acting insulin. No bs is necessary.