Ask The Expert
Insulin

First of all, although I'm not advocating forgetting shots, I do want to say it seems that forgetting a shot is a "rite of passage" with diabetes - i.e. the diabetes is no longer so prominent in your mind that it is monopolizing your every thought-which is a good thing. When patients would call me apologizing for this, I would encourage them to not be too hard on themselves, but rather to just learn from the error, and develop a habit that will prevent them from forgetting shots in the future.

That said, I must first emphasize that the answer to your question must be provided by your healthcare team. Giving specific insulin dosage advice is beyond the scope of this website service. I will explain the principles involved in making the decision on the dose, but it is important that you discuss this with your healthcare professional (HCP).

What You Learned From Your Experience:

• Don't panic.
• Knowing the principles of insulin action will help you understand what to do.
• You run the risk of getting hypoglycemia if you take the full insulin dose several hours too late, since this new dose will overlap with the other insulin doses circulating in your system.

Insulin Principles:

• Unfortunately, although HCPs involved with diabetes usually understand insulin adjustment principles, it is difficult to find this advice in published form. Learning how to adjust insulin requires not only an understanding of diabetes but also a lot of practice and experience-and most importantly, knowing the individual person's specific response to insulin. That is why it is crucial that you discuss all this with your HCP.
• Commonly, if the shot is only 1-2 hours late, you can usually take your standard dose. But this would depend on other factors: Were you more active than usual? Did you eat less? Are you staying up much later than usual, and will not get the normal amount of sleep? Any of the above circumstances could lower your glucose so you might decide that the dose needs to be decreased somewhat.
• A general rule is that if the shot is 3 or more hours late, you will need to reduce your dose, since you "missed" those hours -i.e. your body washed out some of that glucose because insulin was not available to help the glucose get into your cells. In other words, you "missed your chance" with that dose and you need to take less insulin.
• In your situation, you missed a bedtime shot of Lantus, which has approximately a 24-hour action and is intended to provide you with background/basal insulin between meals and during the night. Since you didn't realize this until morning, you already missed probably 8 or more hours of that dose. Then, taking the full dose in the morning-- which was not your usual time-combined with your mealtime Humalog, which gave you too much "insulin on board" during the day-more than you were used to.
• One option would have been to have you take ½ your usual dose of Lantus that morning, since you already "slept through and missed" 1/3 to 1/2 of the dose. Then, that evening, you would be able to resume your usual Lantus dose. Please note that although this is a principle used by some HCPs, it is very individual and must be discussed with your HCP.

Conclusion:

• Forgetting a shot is human-so please don't feel embarrassed about this. I'm sure your HCP would prefer you call for assistance so you can prevent a problem rather than wait until it becomes more serious.
• Decisions on how to adjust a missed dose of insulin vary depending on the type of insulin, the dose, your individual response, how many hours have transpired, and your total insulin regimen for the day. For example, the principles are different for those who take intermediate or long-acting insulin twice a day, or use an insulin pump.
• You must obtain insulin adjustment advice from your HCP, since each situation is different, and individual needs vary.