Question

The client is being treated with Lantus insulin. At 9:00 p.m., the client's blood glucose level is found to be \(200 \mathrm{mg} / \mathrm{dL}\). If the client has an order for Lantus insulin and sliding-scale insulin, the nurse should administer the two doses of insulin: A. Together in one syringe B. Separately in two syringes C. One hour apart in two syringes D. One hour apart in one syringe

Short answer

Answer: Separately in two syringes.

Step-by-step solution

Understand Lantus insulin and sliding-scale insulin

Lantus insulin is a long-acting basal insulin used to control blood sugar levels throughout the day. Sliding-scale insulin is a fast-acting insulin that is administered based on the patient's individual blood glucose levels to correct high blood sugar levels quickly.

Analyze administration methods for Lantus and sliding-scale insulin

Since Lantus is a long-acting insulin and sliding-scale insulin is fast-acting, they have different functions and release rates. Mixing them in the same syringe could cause the insulins to interact and either lose their effectiveness or alter their release rates.

Compare with provided multiple-choice options

Now, let's look at each of the provided options: A. Together in one syringe: This is not recommended, as mixing Lantus with another type of insulin may cause interactions or alter their effectiveness. B. Separately in two syringes: This is a suitable option because administering both insulins in separate syringes would ensure that they do not mix and that they retain their individual release rates. C. One hour apart in two syringes: While administering the two insulins in separate syringes is advisable, there is no specific reason that they need to be given one hour apart unless specified by a healthcare provider. D. One hour apart in one syringe: This is not a suitable option as it involves mixing the two insulins, which may cause interactions or alter their effectiveness. Therefore, the correct answer is option B (Separately in two syringes).

Key concepts

Understanding Lantus Insulin

Lantus insulin, also known by its generic name, insulin glargine, is a type of long-acting insulin. It is specifically formulated to provide a steady, continuous release of insulin that mimics the natural, basal rate of insulin release in the body. This steady release helps to manage blood glucose levels throughout the day and night.
Lantus is typically administered once daily, at the same time every day, to maintain a stable 24-hour glucose control profile. Unlike short-acting insulins, which act quickly, Lantus starts to work several hours after injection and continues to work for approximately 24 hours. This prolonged action helps patients avoid the peaks and valleys often associated with meal-time insulin dosing.
Some key points to remember about Lantus include:

• It should not be mixed with other insulins or diluted before injecting.
• Lantus is often used in combination with other insulins or oral medications for optimal blood sugar control.
• Its onset, peak, and duration make it most useful as a basal insulin in diabetes management.

Exploring Sliding-Scale Insulin

Sliding-scale insulin is a method of managing blood glucose levels in a flexible manner, based on the most recent blood glucose reading. This approach uses rapid-acting or short-acting insulin types to quickly correct elevated blood glucose levels. Unlike basal insulins like Lantus, sliding-scale insulin is meant to manage immediate changes in blood glucose levels, often around meal times.
This method requires regular monitoring of blood glucose levels, commonly before meals and at bedtime. Depending on the reading, a specific dose of insulin is administered to "cover" that sugar level until the next measured period.
Some important aspects of sliding-scale insulin include:

• This method relies heavily on frequent glucose monitoring and immediate insulin adjustments.
• It provides a way to address hyperglycemia quickly and is often used in hospital settings.
• Sliding-scale insulin does not provide a basal level of insulin and is usually combined with other long-acting insulins for comprehensive diabetes management.

Insulin Administration Guidelines

Proper administration of insulin is crucial for effective diabetes management. Given that different insulins have different purposes and pharmacokinetics, it's important to understand the guidelines around administering them.
First and most importantly, as highlighted in the exercise solution, Lantus and sliding-scale insulin should never be mixed in the same syringe. Each has its own time profile and mixing them could alter their effects. Administer them separately to ensure each insulin's effectiveness.
General guidelines for insulin administration include:

• Understand and follow the specific timing for each type of insulin to maintain blood sugar control.
• Use separate syringes for each type of insulin, unless your healthcare provider tells you otherwise.
• Monitor blood glucose levels regularly to adjust insulin doses as needed.

Following these simple yet essential steps ensures that the insulins work as intended, providing effective blood glucose management and minimizing the risk of complications.