Missed Basal Dose - what to do

[DancingStar]

I'm sitting in a&e with my very elderly mother who I can't leave. I've been here since 7pm last night, now 20 past 10 am. I've got my novorapid pen but not my Lantus, which I normally inject about 8am. Anticipate sitting here for further few hours till they find mum a bed. What should I do about missed Lantus? Leave until 8am tomorrow & just use correction bolus doses? I'm confused. Advice please. Thanks.

 

[Lucyr]

That’s quite a personal decision. Is there anyone that can drop off the pen?

The options are really

Either test and correct regularly until you have the basal and take it as soon as you can. Then gradually shift it back to normal time

Or test and correct regularly until your next normal basal time

Or find a way of getting some lantus, eg if anyone can drop it off

 

[Robin]

You’ve got various options.
1.Miss Lantus and correct with Novorapid. This might be more difficult overnight,
2. Take Lantus when you get home, and then gradually move it back to 8am over a couple of days.
3. Take Lantus when you get home, then when you do your next dose at 8am, reduce your breakfast bolus (if that’s when you have breakfast) and watch your levels for a few hours.
4. Take a smaller dose of Lantus, so you might run a bit higher, but when you take your next 8am does you won’t be doubling up quite so much.

Whichever you decide, and there are pros and cons with any of them, do extra testing so you can keep a close eye on your levels. You may find your levels are messed up anyway, if you’ve missed a nights sleep and you’ve had a lot of worry.
I'm sorry you’ve got such a worry on your plate, and hope your mother gets sorted soon.

 

[helli]

In your position, I would keep an eye on my levels and correct with the NovoRapid if you see them climbing.
When you are reunited with your Lantus, you can then decide what to do. I would take it then but take it a little later tomorrow to avoid an overlap.

My advice would be to always take your Lantus with you so you do not have this problem in the future. I always keep all my diabetes kit together.

I hope your mother is ok and finds a bed soon.

 

[rebrascora]

I would go half way between @lucy's suggestion but mostly because I would need masses of bolus insulin to cover for my basal.
In your situation, I would correct with bolus whilst you have no access to the Lantus and then calculate how much of the day is left to your next dose and inject that percentage of your dose. So if you are about 6 hours late then inject about 3/4 of your normal dose, if it is nearer 12 hours late and I very much hope for the sake of you and your mother that is isn't then I would inject half and then resume as normal the next day. Always round down instead of up to play it safe.

Hope your Mam is placed on a ward soon and made more comfortable and you can go and get some rest yourself. You must both be shattered.

 

[Inka]

I’d correct with NR then take the Lantus when you get back/someone brings it to you. I’d then gradually move the Lantus timing back to the correct time of 8am over the next few days.

I hope your mum has a bed very soon xx

 

[helli]

In your situation, I would correct with bolus whilst you have no access to the Lantus and then calculate how much of the day is left to your next dose and inject that percentage of your dose. So if you are about 6 hours late then inject about 3/4 of your normal dose, if it is nearer 12 hours late and I very much hope for the sake of you and your mother that is isn't then I would inject half and then resume as normal the next day. Always round down instead of up to play it safe.

Unfortunately, unlike Levemir, Lantus does not work this way.
It does not last longer because the dose is higher. It will last the same length of time but be less potent. Hence the advice to gradually move the Lantus timing back. It is slightly forgiving because it only lasts 20 to 22 hours for most of us so we can inch it a couple of hours at a time.

 

[DancingStar]

Thank you all for your advice. It's taught me a lesson: I thought take my Novorapid because I'll eat dinner with mum, then after couple of hours go home. I never dreamed I'd be out all night, fretting about my Lantus, an extra worry on top of everything else going on. So from now on it's Lantus & Nr in my bag! And more needles too.

After 19 hour wait in a&e they found a bed for her, hopefully she'll be there for only a day or two. I left her being fussed over by two nurses, which she seemed to be enjoying. I have to say the staff at the QE hospital in Birmingham that mum & I came into contact with were wonderful, all so kind, caring & knowledgeable.

 

[trophywench]

You know - although I realise none of us wants to cause a fuss - had it got difficult on the insulin/BG front, I do believe you could have told a member of staff and asked for their assistance!