A client's diabetes is controlled with a morning dose of glargine and a scheduled, fixed dose of lispro with meals. Before breakfast, the client's fingerstick glucose is 105 mg/dL (5.8 mmol/L). The tray is in the room, and the client is eager to eat. What action should the nurse take?

Question

A client's diabetes is controlled with a morning dose of glargine and a scheduled, fixed dose of lispro with meals.  Before breakfast, the client's fingerstick glucose is 105 mg/dL (5.8 mmol/L).  The tray is in the room, and the client is eager to eat.  What action should the nurse take?

Quizplus · Accepted Answer

11ecbb05_c981_0911_b433_8b62287ebfcc_MD0009_00 Glargine (Lantus) is a long-acting (basal) insulin given to prevent hyperglycemia for 24 hours. The drug has no peak, and so timing of administration is not dependent on food intake. However, if the client is NPO for more than 12 hours, the provider may hold it. Lispro (Humalog) is a rapid-acting insulin with a peak of 30 minutes to 3 hours and should be given only if it is certain the client will eat within 15 minutes. Lispro is prescribed in two ways: Scheduled prandial (ie, fixed dosage) given to prevent hyperglycemia with consumption of food. Typically, this would not be held unless the blood sugar is below normal (70 mg/dL [3.9 mmol/L]) or according to facility guidelines. Correctional (ie, sliding-scale dosage) given to correct hyperglycemia. Typically, this would be held when blood glucose is below 150 mg/dL (8.3 mmol/L). Both glargine and lispro would be given according to schedule, as the client is not NPO and plans to eat immediately, and glucose is above 70 mg/dL [3.9 mmol/L] (Option A). (Options B, C, and D) Holding glargine will increase the blood sugar level over 24 hours. Holding lispro will cause blood glucose to rise uncontrollably due to the consumption of food. Educational objective: Rapid-acting insulin (eg, scheduled prandial fixed dosing, correctional sliding-scale dosing) is given if a client plans to eat within 15 minutes. Scheduled prandial insulin prevents hyperglycemia after meals and is held when blood glucose is below normal (70 mg/dL [3.9 mmol/L]). Correctional insulin corrects existing hyperglycemia.

A Client's Diabetes Is Controlled with a Morning Dose of Glargine