6201522 Lantus Insulin Glargine

NURS 1566 Clinical Form 3: Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name insulin glargine Peak 5 hr

Trade Name Classification Dose Route Time/frequency Lantus hormones 90 units SQ Q HS Onset Duration Normal dosage range Within 1 hr 24 hrs Initiation in patients with type 2 diabetes already being treated with oral antidiabetic agents--10 units once daily; then adjusted on the basis of patient's needs (range 2-100 units/day). Changeover from other intermediate- or long-acting insulin. Decrease total daily NPH dose by 20% during the first week, then adjust on the basis of patient's needs. Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions Diabetes mellitus Do not mix insulin glargine with any other insulin or solution, or use syringes containing any other medicinal product or residue. Solution should be clear and colorless with no particulate matter. Administer subcutaneously once daily at any time during the day, but at the same time each day. Do not administer IV. Mechanism of action and indications Nursing Implications (what to focus on) (Why med ordered) Contraindications/warnings/interactions Lowers blood glucose by increasing transport Allergy or hypersensitivity to insulin glargine. Use cautiously into cells and promoting the conversion of in: Stress, infection (may temporarily increase insulin glucose to glycogen. Promotes conversion of requirements), renal/hepatic impairment (may ↓ insulin amino acids to proteins in muscle and requirements). stimulates triglyceride formation. Inhibits Common side effects release of free fatty acids. Iletin II is derived Lipodystrophy, HYPOGLYCEMIA. from pork; all other are biosynthetic.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Beta-adrenergic blocking agents may block some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Coreg). Alcohol and ACE inhibitors (Prinivil) may ↓ insulin requirements.

Nursing Process- Assessment (Pre-administration assessment) Assess for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nausea; nervousness; rapid pulse; shakiness; unusual tiredness or weakness) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-

Lab value alterations caused by medicine Monitor blood glucose and ketones every 6 hr during therapy, more frequently in ketoacidosis and times of stress. Glycosylated hemoglobin may also be monitored to determine effectiveness. Be sure to teach the patient the following about this medication Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of selection and rotation of injection sites, and compliance with therapeutic regimen. Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term. Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes. Emphasize the importance of compliance with nutritional guidelines and regular exercise, as directed by health care professional. Advise patient to consult health care professional prior to using alcohol or other Rx, OTC, or herbal products concurrently with insulin. Advise patient to notify health care professional of medication regimen prior to treatment or surgery. Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood sugar levels are not controlled. Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and on what to do if they occur. Advise patient to notify health care professional if pregnancy is planned or suspected. Patients with diabetes mellitus should carry a source of sugar (candy, sugar packets) and identification describing their disease and treatment regimen at all times. Emphasize the importance of regular follow-up, especially during first few weeks of therapy. Assessment Evaluation Why would you hold or not give this Check after giving med? Control of blood glucose Overdose is manifested by symptoms of levels without the hypoglycemia. Mild hypoglycemia may be appearance of hypoglycemic treated by ingestion of oral glucose. Severe or hyperglycemic episodes. hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine. Recovery from hypoglycemia may be delayed due to the prolonged effect of subcut insulin glargine. Medication errors involving insulins have resulted in serious patient harm and death. Clarify all

like breath odor; rapid, deep breathing, frequent urination; loss of appetite; tiredness; unusual thirst) periodically during therapy. Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths and from different species. Check type, species source, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.