Question

Emma Arthurs is a 56-year-old Caucasian woman. She has type 2 diabetes, hypertension, and dyslipidemia. Her current medications include glyburide/metformin (Glucovance) 5/500 mg two tablets twice a day, pioglitazone (Actos) 45 mg every day, simvastatin 20 mg at bedtime, and losartan/hydrochlorothiazide (Hyzaar) 100/25 mg every day. She presents to the physician’s office for a follow-up appointment. Her home blood glucose readings are 250 to 350 mg/dL 2 hours after meals and 130 to 160 mg/dL fasting. After examining Mrs. Arthurs and looking at her home blood glucose readings, the physician starts Mrs. Arthurs on insulin glargine (Lantus) 10 mg at bedtime subcutaneously. The physician asks the nurse to teach Mrs. Arthurs to properly inject the insulin.

What should the nurse tell Mrs. Arthurs about injecting insulin and injection site rotation?

Answer 1

Language (insulin glargine injection) 100 Units/mL

Prescription 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.

• Do not use Lantus to treat diabetic ketoacidosis.

E

Important Safety Information for Lantus® (insulin glargine injection) 100 U

Do not take Lantus during episodes of low blood sugar or if you are allergic to insulin or any of the inactive ingredients in Lantus.

Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles.

Before starting Lantus, tell your doctor about all your medical conditions, including if you have liver or kidney problems, if you are pregnant or planning to become pregnant or if you are breast-feeding or planning to breast-feed.

Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus. Your treatment with TZDs and Lantus may need to be changed or stopped by your doctor if you have new or worsening heart failure. Tell your doctor if you have any new or worsening symptoms of heart failure, including:

• Shortness of breath
• Swelling of your ankles or feet

• Sudden weight gain

Tell your doctor about all the medications you take, including OTC medicines, vitamins, and supplements, including herbal supplements.

Lantus should be taken once a day at the same time every day. Test your blood sugar levels while using insulin, such as Lantus. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision.

Do NOT dilute or mix Lantus with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus must only be used if the solution is clear and colorless with no particles visible. Always make sure you have the correct insulin before each injection.

While using Lantus, do not drive or operate heavy machinery until you know how Lantus affects you. You should not drink alcohol or use other medicines that contain alcohol.

The most common side effect of insulin, including Lantus, is low blood sugar (hypoglycemia), which may be serious and life threatening. It may cause harm to your heart or brain. Symptoms of serious low blood sugar may include shaking, sweating, fast heartbeat, and blurred vision.

Lantus may cause serious side effects that can lead to death, such as severe allergic reactions. Get medical help right away if you have:

• A rash over your whole body
• Trouble breathing
• A fast heartbeat
• Sweating

• Swelling of your face, tongue, or throat
• Shortness of breath
• Extreme drowsiness, dizziness, or confusion

Other possible side effects may include swelling, weight gain, low potassium levels, injection site reactions, including changes in fat tissue at the injection site, and allergic

• Injection site:-
• Inject into the less sensitive layer of fatty tissue just under the skin
• It should not be injected into the muscle
• Avoid moles or scars. THE STOMACH

• Except for a 2-inch circle around the navel

• THE TOP AND OUTER THIGHS

  Avoid administering too close to the bony area above the knee

• THE OUTER, UPPER ARMS

  Use the outer back area of the upper arm where there is fatty tissue

Important to remember

• With Lantus, injection sites may be rotated between these three areas (1, 2, and 3 shown above) because the rate of absorption for Lantus is similar for all three
• Each time you inject Lantus, use a different site within those three areas. Also rotate your injection sites as instructed by your healthcare provider
• Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles