# The nurse reviews an older adult receiving insulin glargine. Which action is the priority?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

The nurse reviews an older adult receiving insulin glargine. Which action is the priority?

History

Vitals

Labs

Orders

Notes

An 82-year-old with type 2 diabetes and chronic kidney disease receives insulin glargine 24 units every morning.

BP 118/66 mm Hg, HR 92/min, RR 16/min, temperature 37.2 C.

Glucose 54 mg/dL now; creatinine increased from 1.3 to 2.2 mg/dL over 48 hours; eGFR decreased from 42 to 22 mL/min/1.73 m2.

Insulin glargine 24 units is scheduled now. Hypoglycemia protocol is active.

The client is diaphoretic and reports shakiness. Breakfast is delayed for a procedure.

1

Give the unchanged basal dose because long-acting insulin cannot cause prolonged hypoglycemia.

✕

2

Hold the scheduled dose, treat the current hypoglycemia, and obtain prompt dose review for the renal decline.

✕

3

Double the dose because acute illness usually raises glucose.

✕

4

Skip glucose monitoring after the client eats breakfast.

✕

## Explanation

Current hypoglycemia and rapidly declining renal function make an unchanged long-acting dose unsafe; treat first and obtain authorized dose reassessment.

## In-depth explanation

Quick answer
Treat the glucose of 54 mg/dL, hold the scheduled dose, and request renal-aware basal-dose review.

Why this is correct
Insulin glargine can cause prolonged hypoglycemia, and renal impairment may reduce insulin requirements. The label calls for more frequent glucose monitoring when renal function changes.

Easy analogy or mental picture
A long-acting dose is a train already on the track; reduced clearance can make the trip longer, not safer.

Memory hook
Low glucose plus falling kidney function: treat, hold, reassess dose.

NCLEX decision rule
Address active hypoglycemia before giving more insulin and match future dosing to the new physiologic state.

Why the other choices are wrong
Acute illness does not justify ignoring a measured low glucose, and eating once does not remove the risk from a long-acting dose.References
1DailyMed: Insulin GlargineHypoglycemia risk and closer monitoring in renal or hepatic impairment

## Clinical scenario

Basal-insulin review
Trend glucose, renal function, intake, recent dose changes, hypoglycemia symptoms, and rescue response.

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