Would you hold Lantus?

It could be beneficial, depending on the patient's status.

Would never do it without an order... endocrinologists get paid a lot more than I do

I definitely would not hold it without talking to the doc. If AM blood sugars have been running low every morning after the pt was given Lantus the night before, I would definitely call the doc to see if they want an adjustment.

A friend did a presentation on evidence-based approaches to this question. The general answer was it is generally OK to give Lantus after giving OJ or otherwise correcting blood sugar, but it sounds good to also notify MD and look at past trends. And it is good to check BG before giving. However, the evidence was clear that it's not indicated to hold Lantus for low blood sugar alone without an order, due to the pharmacokinetics of this insulin as opposed to all the others.

Unlike most other insulins, Lantus has no peak of action, simply a long plateau after the 2-4 hours till its onset. So the BG 2-4 hours after administration is the one you'd be concerned with more so than pre. If in doubt, you could check that. And the Lantus from the previous day is still somewhat in the system. But the goal is management of BG all day rather than preventing momentary lows, unless those become trends or are too extreme (or so I've heard?).

If the person has IV access and is not nourishing themselves well, there's dextrose. If not, there's glucose on the gums. Or sugar.

Has anyone found a case of hypoglycemia that hasn't responded to any of these?

There are so many variables. If Lantus were the only insulin being used, and BG had all been normal, I'd give with an HS snack.

We frequently have extremely noncompliant pts. They take HUGE amts of insulin to control BG at home where they eat cake, pie, Big Macs....... When they come to the hospital we continue the same dose of insulin on an 1800 calorie diet. It's only a matter of time until disaster strikes.

I know of someone with type 1 who does not respond to oral glucose

However, before making any decisions, I would call the patient's doctor, make him/her aware of the blood glucose reading of 68, and see how he/she wants to proceed.

This is something that anyone should do with any ordered med. It covers your "assets" and lets the MD make the best decision for that patient.

Honestly I would give it, it's not that low and Lantus provides long acting coverage wouldn't drop the blood sugar