Would you give Lantus without BG check?

danh3190 · May 22, 2011

I do check it, but I'm more interested in how much the patient's likely to be eating in the 24 hrs or so the Lantus will be working in his system as well as knowing how his sugars have been running lately. I'm not as worried about a particular number.

Schmoo1022 · May 22, 2011

We have three residents who are on Lantus and they do not have BG's ordered. I do check their BG prn if they haven't eaten or are not feeling well, but they do NOT have any standing orders for BG's

mazy · May 22, 2011

We give it where I work, usually just do a once a week FSBS to assess baseline. With patients on routine FSBS I've called docs when BS is low to ask about giving Lantus and they always give me the go ahead, just give a snack. Lantus is a med that you don't want to mess around with once it gets to it's therapeutic threshold in the system.

madwife2002, BSN, RN · May 22, 2011

http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0000004/

Eiano · May 22, 2011

Usually for someone to be on Lanuts, it has to be established that their BG are generally elevated. Where I work, there is an order for "notify prescriber for BG

Daisy_08, BSN, RN · May 22, 2011

Depends on the pt. In acute pt's or those who have had a recent change in status or newly diagnosed I would check BG first. But in Retirement with stable pt's, I don't check BG, unless my assessment leads me to.

Anna Flaxis, BSN, RN · May 22, 2011

In a patient who has been on Lantus forever and a day, who is not ill with N/V/D, sure, I'd give it w/o CBG. If it's new for the patient, or there has been some change in their condition for the worse, then I'd be more inclined to check a CBG.

That Guy, BSN, RN, EMT-B · May 22, 2011

If its a low dose and the pt is eating well, I usually am not too concerned. Its the 85unit dose I gave the other night that had me doing circles on whether to give it or not.....

Aeterna, BSN, RN · May 22, 2011

Depends on the patient.

For the most part, since I'd be giving the Lantus regardless, it's not a huge deal to give it without checking the blood sugars, particularly if the patient is eating well and their sugars are pretty stable. I have a patient on my current assignment who gets a low dose of Lantus qhs but she has no other insulins and she eats well so we don't bother checking before giving it.

Then there are the patients who you know have whacky blood sugars that are all over the place and what have you. Or if they're a newly diagnosed diabetic. Or if the Lantus dose was high. Then I would probably check the blood sugars.

talaxandra · May 22, 2011

My patients are usually prescribed Lantus nocte (given at 2000, and therefore 2/24 post their pre-dinner BSL) or mane and nocte (and therefore also with their pre-breakfast BSL). Left to my own devices I wouldn't check before giving any ultra long-acting insulin, though i would check overnight if I had concerns about them bottoming out.

However, I work in a teaching hospital. I don't want any of my less experienced nurses to get the idea that insulin can be given without checking the BSL. it's also hospital policy that insulin only be given within 15 minutes of a serum glucose reading. For these reasons I always check BSL's before giving insulin of any kind.

NurseIn11 · May 23, 2011

I'd look at their trends. A spot check won't really tell you much since Lantus doesn't peak. If they tend to drop every day around the same time or whatever, I'd suggest a change in dosing. If they're stable and have been on that dose for a long time, I wouldn't worry too much. A lot of people take Lantus at home and don't check but once or twice a day (at least they're supposed to) and they're fine.

That being said, like anything in nursing, it all depends on the patient! =)