Lantus - what's protocol here?

[mirror]

My 20 year old is in hospital (not diabetes related)
Her blood sugar had been low (she's on a reducing dose of steroids so this means as they reduce lantus needs reducing). on Monday it was about 3.4 when evening lantus due.
They didn't inject lantus but gave half a dose in the morning.
Still low all day.
They gave her full dose last night.
They found her collapsed on the floor this morning 0.9 bm.
She's in the ambulatory assessment centre.
I think they should have given less lantus on Monday but still at night.
To me this is obviously happened because there's double (well nearly)in her system. Apparently Dr (not diabetes related) doesn't agree.
What do you think?

 

[noblehead]

Hi @mirror and sorry to hear that your daughter is in hospital.

Get the team that is looking after your daughter to contact the hospital diabetes clinic and ask that a DSN or Consultant comes up to the ward to advise.

 

[mirror]

well, the diabetes nurse knows - but I think they are covering themselves.
when we do have a meeting on Thursday (about discharge due to what else is wrong with her) they were looking at discharge on Friday but now want to delay it. if which I expect she will be fine by then I want to say that I think that the wrong injection protocol is the reason for this happening, and not because some weird thing is wrong with her.

does anyone think it was likely that an injection overlap may be a potential cause?

 

[Ambersilva]

As you know Lantus is mostly a 24 hour long acting insulin to keep the blood sugar at a steady level. But it does have the potential to lower blood sugar too far if too much is given. The half dose morning insulin would have still been in her system when the full evening dose was given.

I inject Lantus in the evening and then with only a difference between injecting 11 or 12 units can have a substantial effect in lowering my morning blood sugar level. If my Blood sugar level is too low in the morning I inject 1 or even 2 units less Lantus in the evening.

@noblehead has given sound advice in post #2.

 

[novorapidboi26]

Are the people administering the insulin diabetes qualified.........?

is your daughter able to take control of her own insulin?

 

[ButtterflyLady]

You may be interested in these guidelines:
https://www.diabetes.org.uk/About_u...ions/Self-management-of-diabetes-in-hospital/
https://www.diabetes.org.uk/About_u...ions/Self-management-of-diabetes-in-hospital/

The second link cites coming off steroids as a risk factor for hypos.

Once she is out of hospital, she should request her notes so a formal complaint can be made, if desired.

 

[mirror]

she isn't able to self manage no unfortunately. will read those links in a bit
the diabetes nurse wanted her to have 12 units when she had a mcdonalds at lunchtime - she said she felt hypo still, and my husband got them to check her bm - 2 point something

 

[ButtterflyLady]

she isn't able to self manage no unfortunately. will read those links in a bit
the diabetes nurse wanted her to have 12 units when she had a mcdonalds at lunchtime - she said she felt hypo still, and my husband got them to check her bm - 2 point something

So the DN wanted to give insulin without checking her BG? Lots to complain about here, I think.

 

[Ambersilva]

12 units of fast? acting insulin for a McD. Way too much IMO. Last week I had a McD Quarter Pounder. I ate half of the bun plus some of my grandsons fries. Total injection 4 units.

 

[mirror]

that's not neccesarly out - because normally she is on a ratio of 2 units per 10g of carbs - don't know what the mcdonalds was as I wasn't there - but it could easily be around 60g (although they 'don't carb count in hospital' apparently - they just go by what the doctor prescribes and cant vary it) - she has been an inpatient since april and is due to come out in theory on Friday - however they said they want to review the insulin on Friday and keep her in... god knows they will come up with some stupid excuse why they are not in the wrong ?
could it ever be right to give the insulin in the morning, instead of the night - and then give full dose in the next night?
They are so tricky I want to know my facts before our scheduled meeting on Thursday this week.

 

[Ambersilva]

12 units of fast? acting insulin for a McD. Way too much IMO. Last week I had a McD Quarter Pounder. I ate half of the bun plus some of my grandsons fries. Total injection 4 units.

Lantus® is a long-acting insulin used to treat adults with type 2 diabetes and adults and pediatric patients (children 6 years and older) with type 1 diabetes for the control of high blood sugar.

@SweetLucie I know exactly what Lantus is and how I use it effectively for me...

 

[Ambersilva]

she isn't able to self manage no unfortunately. will read those links in a bit
the diabetes nurse wanted her to have 12 units when she had a mcdonalds at lunchtime - she said she felt hypo still, and my husband got them to check her bm - 2 point something

Even if 2 or 3 units too much fast acting insulin are given, low blood sugar will result. You can find the carb value of most food products by googling the product name followed by carb content. Perhaps your daughter's insulin to carb ratio has changed. Some T1s on here have different ratios for different times of the day.

 

[mirror]

I understand that.
Obviously even considering giving 12 units (because that's the 'lunchtime dose' some doctor decided if she eats lunch (forget what it is!) Without checking bm when she'd been dangerously low due to their mistake (which they probably won't admit) and then when patient says she still feels hypo and they do check bm and it's 2.6... Not good.

 

[TooMuchGlucose]

I understand that.
Obviously even considering giving 12 units (because that's the 'lunchtime dose' some doctor decided if she eats lunch (forget what it is!) Without checking bm when she'd been dangerously low due to their mistake (which they probably won't admit) and then when patient says she still feels hypo and they do check bm and it's 2.6... Not good.

That's absolutely ridiculous, millions of type 1s around the world do this every day because it's important, even more so in hospital. These doctors are seriously putting your daughter at risk with not checking her blood sugar beforehand. You need to tell the doctors how important it this is, because the care she's receiving right now is disgraceful. You said the diabetes nurse knows about the situation, is that the one attached to the hospital or one your daughter sees outside of hospital?

 

[mirror]

Attached to the hospital
I don't know who advised to give lantus in morning instead of night causing the double dose.
Presumably a doctor (I hope not the diabetes nurse)

 

[TooMuchGlucose]

Try to get hold of her diabetic team outside of hospital, this nurse in the hospital clearly isn't doing her job properly if she did advise the double dose. Hopefully the team outside of the hospital can either scream at them on the phone or do something to get help her out.

 

[mirror]

Unfortunately she has nothing currently in place.
She had been at university without a dn
Prior to that at home the diabetes management was hit and miss but she had been under a team to an extent.
I'm planning to write to chief executive and let the mdt know prior to our meeting on Thursday. I don't want them keeping her in. As it was planning discharge this Friday. We can manage the diabetes.

 

[TooMuchGlucose]

That sounds like a good idea, I'm not really sure what else you can do other than staying by her all the time making sure that her blood sugar is being checked etc. I hope she does start to feel better soon.

 

[Daibell]

I understand that.
Obviously even considering giving 12 units (because that's the 'lunchtime dose' some doctor decided if she eats lunch (forget what it is!) Without checking bm when she'd been dangerously low due to their mistake (which they probably won't admit) and then when patient says she still feels hypo and they do check bm and it's 2.6... Not good.

Hi the reason the poster queried the use of Lantus with a McDonalds is that it should not be used for mealtime carbs. Lantus is a 24 hr background insulin only. If your daughter should need more insulin for mealtime carbs as well after the steroids have gone right down and her blood sugar needs better control, then additional Rapid insulin such as NovoRapid would be precribed for mealtime use as well. Some people do do two injections of Lantus per day (morning and evening) but the total dose for both is adjusted to be a similar to the amount one single total dose would be.

 

[mirror]

I think there is a misunderstanding then - the 12 units for the McDonalds is Novorapid and not of course Lantus.
we have been down this road for 19 years with this child and 6 years with another one