Forgot to Take Insulin Before My Meal – What Now?

Forgetting to inject insulin is a very common problem that many people with type 1 diabetes face. Whether you were diagnosed years back or are newly diagnosed, it’s pretty easy to miss your insulin dose before a meal. 

People who are newly diagnosed are usually young and simply not used to it, whereas those who are a bit older, might forget to do so because they are tired or busy or out. 

Insulin is the main medical treatment for the control of type 1 diabetes. So, when you forget to inject insulin before a meal it can have some serious consequences. This is why you should know what to do if you miss an insulin injection before your meal. 

Why Is It Important to Take Insulin Before Meals?

Insulin injections are divided into two categories – Basal insulin and Bolus insulin injections. 

  • Basal doses are basically maintenance doses to manage blood sugar levels during the day. A basal insulin formula is a long-acting one. It can last either 24 hours or 12 hours, depending on the insulin formula you use. 

It doesn’t have a very high peak, but instead, it remains at a steady level throughout the day. This way it keeps resting blood sugars in check.

Basal doses are usually injected once per day and will last 24 hours, or they are injected twice a day if they are the 12-hour formula. 

  • Bolus doses, on the other hand, are additional doses that you must inject before eating a meal. These are short-acting or ultra-short-acting and have a drastic peak but their action wears off much faster than that of a basal insulin formula. So, these will bring down your glucose levels very quickly in the case when there’s a spike, like after a meal, but they will not continue to impact the blood sugar levels after a few hours have elapsed.

Since bolus doses are short-acting, don’t stay in your system too long and have a drastic effect, they’re only injected at mealtime or up to 20-30 minutes before mealtime. They reach peak levels in 30 minutes to 4 hours, depending on the insulin used, and only last in the bloodstream for three to six hours. 

Bolus doses are extremely important in maintaining good glycemic control and missing them can have both long-term and short-term negative impacts. 

Short-Term Problems

When you have a meal with a lot of carbs or even a normal amount of carbs, it leads to a rise in your blood glucose levels. Now, if you’ve forgotten to inject a bolus dose before this, it can lead to your blood sugar levels reaching very high levels. Often this can then lead to you feeling a bit ill. 

If the sugar levels get dangerously high, it can cause an acute and potentially life-threatening complication known as Diabetic Ketoacidosis

Long-Term Problems

If you miss your bolus doses regularly, it can lead to poor control and high HbA1c, and overall deterioration of your health as a result of long-term complications of diabetes like diabetic neuropathies where the nerves are damaged or damage to other organs like the kidneys, eyes, blood vessels, etc. 

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Symptoms of a Missed Bolus Shot

If you miss a shot of bolus insulin, you may experience some symptoms because of your blood glucose being too high. These can include: 

  • Increased thirst
  • Increased urination
  • Fatigue
  • Headache
  • Blurry vision 

These are some general symptoms of hyperglycemia or high blood sugar. But if your blood sugar levels get dangerously high, you can develop Diabetic Ketoacidosis. That presents some additional symptoms that you should be careful about. Additional symptoms for DKA include:

  • Nausea
  • Vomiting
  • Lethargy
  • Drowsiness
  • Fast breathing
  • Excessive sweating
  • Dry skin and mouth
  • Fruity smelling breath
  • Stomach pain

If you notice these things in yourself or someone else with diabetes, you need to get medical help instantly. The condition of someone with Diabetic Ketoacidosis can worsen very quickly and lead to serious complications. 

What To Do If You’ve Missed a Bolus Shot?

Now, if you’ve realized that you’ve forgotten to inject a bolus shot, don’t panic! You should prepare for a moment like this by speaking with your physician and clarifying what the procedure should be. The following is not medical advice, and you should always check with your endocrinologist or doctor to establish a plan beforehand.

That said, keep calm and follow these general guidelines to get back on track:

  1. First of all, you need to check your blood glucose levels as soon as you remember that you missed the dose. No matter how long it has been since you missed it and even if you are feeling okay, just check your sugar levels ASAP.
  2. If it hasn’t been over 1 hour since your meal, you can just inject your bolus insulin like you usually do. So simply count your carbs, figure out the dose, and inject it. But you still need to be careful. You have to continue to monitor your blood sugar levels since there is a change in your schedule.
  3. If it’s been more over 1 hour since you ate, and your blood sugar levels are high, use that value to calculate how much insulin is needed to correct your glucose levels and administer that dose. If you are not sure about it, you can contact your doctor or a healthcare provider to find out the exact amount. 
  4. Once you have injected the missed dose, you need to continue to monitor your sugar levels every two hours. Or until they are in a safe range. If you think they are not going down and keep rising, or you start feeling ill, it’s best to go to the hospital. 
  5. If you notice any of the symptoms of DKA, you should check urine ketones with an at-home kit. If they are high, hydrate yourself and rush to the hospital. If you don’t have a test kit, it’s best to go to the hospital. 
  6. Even if you have administered the dose and your sugars are going down, make sure to drink plenty of water. Also, don’t put too much physical or mental stress on yourself until you’re within the normal range. 
Forgot to Bolus Before a Meal Infographic

Final Thoughts

It’s completely normal for people to forget their insulin doses, so you don’t need to stress out too much or feel guilty about it. But what you need to do is be more careful and simply act fast to fix your blood glucose levels. 

Simple steps like checking your sugars, administering the right dose, staying hydrated, and keeping an eye on your symptoms are usually enough to get you back in range. 

But, if it happens regularly, it can mess with your glycemic control and that can then lead to long-term complications. So, if you do miss a bolus shot, just see what went wrong and use a reminder system in the future to make sure it doesn’t happen again.