blood sugar drop in middle of night...

I work from 3-11pm shift and the evening nurse told me that the blood sugar has dropped < 50 for one of the patients. So she told me to make sure this patient gets a bed time snack. So, that evening told the CNA to make sure to give the patient a snack at bedtime. Next time I come back, havent heard anything. The following night, told the evening nurse that I personally fed the patient before bedtime so she knew. Weekend off, morning nurse told me blood sugar was <50 again with same patient. Fed the patient again, made sure other DM patients got some snack. I happened to be staying a few extra hours charting, and 0100, CNA said 3 patients were diaphoretic. the evening nurse checked BS on all 3 and <50! Ill be doing a 12 hours shift 7p-7a, so if it happens again tonight, im calling the MD to mayb get the dosage changed or something... right? Im wondering, if its something that im not doing, or perhaps I shouldnt be giving lantus at bedtime, but I wouldnt I need an order to hold lantus? Thoughts and advice are greatly appreciated.
This might be part of the Somoygi effect (nocturnal hypoglycemia followed by preprandial hyperglycemia). Unless it is dangerously low, changing insulin order before bedtime can actually make things worse. Make sure that "night-time" snack is mostly protein with minimal carbs, like an egg, or a protein bar. Hope this helps!

Lantus is not what's making the patients hypoglycemic. It has little to no peak. Are you giving NPH at night? If not, then it's likely that the short acting insulin doses are a little too high because of the previously mentioned Somoygi effect. Bedtime snacks should usually contain something like two to three protein exchanges, one carb exchange, and perhaps one milk exchange. Providing only carbs at bedtime causes an insulin spike and subsequent blood sugar drop.

Did patients get sliding scale coverage at dinner or HS, or oral diabetes meds? Perhaps the SSI is a little too aggressive, or patient is not eating well, or is getting too much oral agent. Lantus might need to be adjusted as well, but as per previous poster, it is not short acting and shouldn't be dumping your glucoses unless seriously overdosed (and then, you'd have low glucoses x24 hours.) Likely the provider should look at overall regimen and see what can be done. Usually they can figure out what the problem is pretty easily and fix it.

I do no understand why the MD was not notifed after the first event.

Quote from hearticultureThis might be part of the Somoygi effect (nocturnal hypoglycemia followed by preprandial hyperglycemia). Unless it is dangerously low, changing insulin order before bedtime can actually make things worse. Make sure that "night-time" snack is mostly protein with minimal carbs, like an egg, or a protein bar. Hope this helps!

Quote from classicdameI do no understand why the MD was not notifed after the first event.

Quote from lkwashingtonI agree the patient could have received a amp of glucagon IM or D50 IV.

Quote from iluvnoodlesI work from 3-11pm shift and the evening nurse told me that the blood sugar has dropped < 50 for one of the patients. So she told me to make sure this patient gets a bed time snack. So, that evening told the CNA to make sure to give the patient a snack at bedtime. Next time I come back, havent heard anything. The following night, told the evening nurse that I personally fed the patient before bedtime so she knew. Weekend off, morning nurse told me blood sugar was <50 again with same patient. Fed the patient again, made sure other DM patients got some snack. I happened to be staying a few extra hours charting, and 0100, CNA said 3 patients were diaphoretic. the evening nurse checked BS on all 3 and <50! Ill be doing a 12 hours shift 7p-7a, so if it happens again tonight, im calling the MD to mayb get the dosage changed or something... right? Im wondering, if its something that im not doing, or perhaps I shouldnt be giving lantus at bedtime, but I wouldnt I need an order to hold lantus? Thoughts and advice are greatly appreciated.

Quote from chloecatrnNo need for glucagon or D50 if the patient was arousable. Wake, give crackers with peanut butter and some apple juice, recheck in half an hour. Repeat if not above facility threshold for hypoglycemia.