Administering Insulin for a Patient with Blood Glucose of 279 mg/dL at 2 AM
Yes, you should administer both the scheduled Lantus 30 units and Lispro 6 units sliding scale for this patient with a blood glucose of 279 mg/dL. This is consistent with current hospital diabetes management guidelines.
Rationale for Administration
- Basal insulin (Lantus/insulin glargine) plus correction insulin (Lispro/insulin lispro) is the preferred treatment for hospitalized patients with hyperglycemia, especially when blood glucose levels are elevated above target range 1
- A blood glucose of 279 mg/dL indicates significant hyperglycemia that requires treatment to prevent further metabolic derangement 1
- Using only sliding scale insulin without basal insulin (Lantus) is strongly discouraged in hospital settings as it leads to poor glycemic control 1
- Delaying insulin therapy in patients not achieving glycemic goals is not recommended (B rating) 1
Insulin Administration Guidelines
- For hospitalized patients with hyperglycemia, a regimen with both basal insulin (Lantus) and correction components (Lispro) is the standard of care 1
- Lantus (insulin glargine) provides essential background insulin coverage for 24 hours 1, 2
- Lispro (insulin lispro) is a rapid-acting insulin analog that helps address immediate hyperglycemia 3, 4
- For patients not eating (as may be the case at 2 AM), glucose monitoring every 4-6 hours with appropriate insulin administration is recommended 1
Important Considerations
- After administering insulin, continue to monitor the patient for potential hypoglycemia, especially during nighttime hours 1
- Document the administration and subsequent blood glucose readings in the medical record 1
- Ensure the scheduled 7:30 AM blood glucose check is performed to evaluate the effectiveness of the insulin administration 1
- Verify that the patient has no contraindications to receiving the prescribed insulin doses 1
Hypoglycemia Prevention
- Be aware of the risk of hypoglycemia, particularly during overnight hours 1
- Have hypoglycemia treatment protocols readily available 1
- If hypoglycemia (<70 mg/dL) occurs after administration, follow your institution's hypoglycemia management protocol and document the episode 1
- Consider reviewing the insulin regimen if repeated hypoglycemic episodes occur 1
Common Pitfalls to Avoid
- Withholding basal insulin (Lantus) when blood glucose is elevated is a common error that leads to worsening hyperglycemia 1
- Using only sliding scale insulin (Lispro) without basal insulin leads to poor glycemic control and glucose variability 1
- Delaying insulin administration when indicated can lead to worsening hyperglycemia and metabolic complications 1
- Failing to monitor blood glucose after insulin administration increases risk of undetected hypoglycemia 1