I think i forgot to take my insulin at breakfast, what should I have done?

[sololite]

Work up this morning a bit tired and fuzzy, went through my morning routine, had breakfast and got on with my chores . I didn't check ny BS until mid morning and saw they were very high. I ran through what I'd eaten and started to think I'd missed my Novorapid injection with breakfast. The more you try to remember, the less certain you become. I chose to wait till lunchtime and put in a correction. Then for good measure I went for a bike ride. Things returned to usual by tea time. Should I have taken a different course of action?

 

[Lucyr]

Why wait and leave it high until lunchtime? I’d have corrected straight away

 

[sololite]

Hi Lucy.I was scared of doubling up. My BS is a bit of a roller coaster at the moment following a Pancrectomy and I'm trying to identify patterns to help me smooth things out.

 

[Lucyr]

Hi Lucy.I was scared of doubling up. My BS is a bit of a roller coaster at the moment following a Pancrectomy and I'm trying to identify patterns to help me smooth things out.

You could have adjusted the correction for the iob that would have been left if you had injected though

 

[Inka]

In your circumstances I’d have erred on the side of caution too @sololite I went through a period when my bolus didn’t seem to work then suddenly kicked in and down I dropped. I think I’d have waited X amount of hours then corrected, or done a mini-correction and then corrected again later if necessary.

I don’t think there’s any one way to do it. You have to do what works for you. I understand the concern of doubling up - and the trawling of your memory to try to work out if you injected or not. There are pens that record your doses so you know you’ve taken it. Perhaps they would help?

 

[RBZ5416]

Presumably you're using disposable pens? As well as the environmental issues, switching to a re-usable pen would also give you confirmation of dosing.

 

[Bruce Stephens]

The more you try to remember, the less certain you become. I chose to wait till lunchtime and put in a correction.

You could have taken a small dose just to reduce BG a little.

And, of course, ask for a reusable pen because then you can check.

 

[Lucyr]

Presumably you're using disposable pens? As well as the environmental issues, switching to a re-usable pen would also give you confirmation of dosing.

That depends on which insulin you use thohgh. They’re available for novorapid but not for apidra.

 

[Proud to be erratic]

I probably would have waited @sololite. I'm certainly old enough to not be concerned about sitting on the high side for a modest period, particularly with c.75-80% TIR usually; and the brittleness of my BG does mean that fluctuations can be unexpected or just downright rapid. But I do have rechargeable pens and if I'd happily established that I had missed my breakfast bolus I might have then taken the correction. But I also often skip lunch and that extra delay would also possibly have got me correcting rather than wait for dinnertime.

One of the things I do find interesting (and yet frustrating) when I make this mistake, is that the insulin correction needed is always bigger than the bolus I would have routinely taken for the missed meal. One of life's mysteries!

 

[Mumpie_olgran]

One of the things I do find interesting (and yet frustrating) when I make this mistake, is that the insulin correction needed is always bigger than the bolus I would have routinely taken for the missed meal. One of life's mysteries!

I find this reassuring to read. I think I've picked up the same pattern with me too. Sometimes put s other way in that my bolus needs to be much higher if I'm starting on higher BS whether or not it's a correction

 

[everydayupsanddowns]

One of the things I do find interesting (and yet frustrating) when I make this mistake, is that the insulin correction needed is always bigger than the bolus I would have routinely taken for the missed meal. One of life's mysteries!

I find this reassuring to read. I think I've picked up the same pattern with me too. Sometimes put s other way in that my bolus needs to be much higher if I'm starting on higher BS whether or not it's a correction

It is an odd thing that isn’t it - but something that is often mentioned on the forum. Almost as if there’s a degree of insulin resistance that happens when BG is above a certain point. And of course correction doses for highs take simply yonks to actually get going, which doubles the risk of an additional (and inadvisable!) rage bolus.

Added to this mystery, of course, is the odd way that a unit (or sometimes even a fraction of a unit) too little basal (spread over 24 hours) can seem to invoke a need for units and units of bolus corrections.

Diabetes Maths (TM) is a dark art, that’s for sure.

 

[RBZ5416]

That depends on which insulin you use though. They’re available for novorapid but not for apidra.

I'd missed my Novorapid

🙄

 

[Mumpie_olgran]

a unit (or sometimes even a fraction of a unit) too little basal (spread over 24 hours) can seem to invoke a need for units and units of bolus corrections.

Yes I think of it rather like catching a wave while surfing (which I'm also not very good at!)

You can paddle away like mad (bolus) while the current is slightly against you (fractionally low basal) and not make any progress. And then suddenly you get on the right side of the wave (correct basal) and a couple of slight pulls with the arms (bolus) and you can effortlessly pull away

With the obvious additional parallel of overcooking it and plunging headfirst underwater of a hypo!

Poetry over

 

[Lucyr]

🙄

Yes you can use them, I know that, that’s why I said they’re available for your insulin, novorapid. Not everyone can use a memory pen. The original post suggesting a reusable pen could have sounded to other readers like anyone can just switch to a reusable pen which would have a memory function. Many people read the forum without posting so it’s good to be clear for them that it’s only novorapid they’re available for.

 

[helli]

One of the things I do find interesting (and yet frustrating) when I make this mistake, is that the insulin correction needed is always bigger than the bolus I would have routinely taken for the missed meal. One of life's mysteries!

This was always explained to me as insulin resistance when my BG is high which means I need more insulin and it can take longer to.start working.

Unlike you, I would not leave my BG high as it can make me feel lousy if only for a modest period. Given the delay in insulin activation when high, this modest period could be extended.
It is definitely a choice we need to make but, if more than a couple of hours since eating and my BG is still rising, I would take a conservative correction to being my BG down before my next meal.
I avoid eating when my BG is over 10 and hate missing meals so I want to correct as soon as possible to bring my BG down to "eating levels".

 

[Lucyr]

It also doesn’t need to be just when you forget that you can take a correction between meals. Example, I’m currently 8.3, know my bg goes up if anything in the morning never down, my pancreas can’t be bothered in the mornings, and I’m not planning on breakfast for an hour or so. So I’ve taken 2u by itself without breakfast because I might as well bring it down to better bgs before eating. I’ll account for that iob at next meal, made a note that I took it.

No point waiting until the meal to correct I might as well get to a better bg as soon as I can. Perhaps needs some confidence or experience, but you don’t need to be restricted to correcting with meals.

 

[rebrascora]

Many people read the forum without posting so it’s good to be clear for them that it’s only novorapid they’re available for.

Just to be clear, Fiasp can also be used in the same pen, so not just NR. And of course Levemir and I assume Tresiba too. I would be lost without my NovoPen Echoes!

If y levels get to 8 and rising and I know they shouldn't, then I inject a correction. My alarm is set at 9.2 and barring very exceptional circumstances I always inject a correction when it goes off, even if I injected a correction half an hour ago on 8.2 with an upward sloping arrow and if it continues to go up to 9.6 half an hour later it gets hit with another unit. This was a tactic I developed with Fiasp and Libre, as once my levels get above 10 Fiasp is like water and it is clearly less effective above 8, so I am really proactive about keeping it below 10. Once I get above 10 I will be there for hours and it will take lots of insulin and the temptation to "rage bolus" is high, so I stack small corrections if necessary to keep it below 10 and keep a close eye on Libre for them kicking in. Not sure I would do this stacking with NovoRapid because it is slower and from my recollection more able to deal with higher BG levels but for me Fiasp is a total wimp when it comes to doing battle with high levels and it needs 2 or 3 reinforcements to bring me down again. The advantage of Fiasp is that it is faster and if I am mot seeing it turning the tide in half an hour, I can be pretty sure I need more.... unless I can get out and get some exercise to help it.

I totally agree about basal insulin seeming so much more powerful than bolus and as you say Mike, half a unit too little and you are needing several units of bolus insulin in corrections to compensate/balance things. Getting the correct basal insulin dose (particularly overnight) is certainly a dark art for me but one that I am definitely improving at.

 

[SimonP]

I think I'd have done a bolus, perhaps not for the full breakfast amount, and had some food to hand to start eating if it decided to drop. I log my insulin (and food) in XDrip+ which gives me a nice graph, though for my basal I also have a piece of paper with boxes to tick in the pen case and I fill it in without fail before doing anything else (I do sometimes forget to add things to XDrip+ - I pick up the phone and get distracted).

I also suffer from higher insulin resistance when I'm high, it can take a very long time to come down after my dawn phenomenon if I don't get a decent bolus in asap once I'm up (even if not very high, say 12mmol/l or thereabouts).

Exercise does change this (insulin sensitivity in general) though - this morning I messed up my pre-ride bolus reduction and had a blood glucose of 22mmol/l with little to none of that bolus IoB (I was pre-occupied, and expected it to start coming down on its own). I eventually decided to take 1U of Novorapid and it then dropped 14mmol/l in the space of an hour and a half and was continuing down so I had to start eating! This may be good timing and therefore partly down to liver glycogen depletion (about 1h30 into the ride), but still the effect of insulin is quite large and made larger when exercise.

So some exercise is probably a useful thing to do for stubbornly high blood glucose (I didn't have these stubbornly high blood sugars when I was walking the kids to the local school for example).