What to Do If You Miss a Dose of Mealtime Insulin

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The aim of any type 2 diabetes treatment is to control your blood sugar levels so they don’t swing too high or drop too low, which can damage your body and lead to diabetes complications. Different treatments work for different people, and the treatment that works best for you may change over time. Many people with diabetes need insulin therapy for good blood sugar control at some point in their lives. For some, that means background insulin, which is usually taken once a day and lasts for 24 hours. Examples of background insulin include insulin glargine (Lantus, Toujeo), insulin determir (Levemir), and insulin degludec (Tresiba). For others, this background insulin isn’t enough. They’ll also need rapid-acting mealtime insulin, which is taken 10 to 30 minutes before a meal and lasts for four to six hours. Examples of mealtime insulin include insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glulisine (Apidra). When you take your mealtime insulin and how long it lasts depends on the specific type of insulin you take.

It's important to make sure you understand your mealtime insulin window by talking with your doctor and following the instructions on your insulin label. If you miss a dose, your next steps depend on when you realize you missed it.

Mealtime Insulin Dosage: What Makes Yours Unique

Your doctor works with you to establish your A1C, or blood sugar, goal based on several factors, including:

  • Your personal history and risk of low blood sugar

  • How long you’ve had diabetes

  • Diabetes complications you’ve experienced

  • Your age

Your doctor then determines your mealtime insulin dose based on your blood sugar goal, taking into account the number of carbohydrates you typically eat. You’ll also likely receive a correction dose as a backup in case your carb counts are off for a meal. Counting carbs is key for managing diabetes and properly dosing mealtime insulin. Carbohydrates become sugar when digested, and insulin helps your body store and use this sugar for energy. Without insulin, sugar stays in your blood stream, leading to high blood sugar levels that can cause serious problems. That’s why your doctor works with you to make sure you get the right amount of insulin to avoid complications.

When you skip a meal, all of this planning to control your blood sugar is thrown off. Missing a meal can’t always be helped, so don’t beat yourself up if it happens. Just be aware that missing meals can have serious consequences when you’re taking mealtime insulin, so it’s best to eat regular meals as much as possible. Missed and delayed meals can lead to both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Severe hypoglycemia can be immediately fatal, and hyperglycemia, over time, can lead to kidney failure, blindness, heart problems, and amputations.

Making Up Mealtime Insulin for Diabetes: Before, During & After You Eat

You may not realize you’ve missed your mealtime insulin until after you’ve cleared your plate. Or you may realize it when your food isn’t ready as soon as you thought it would be. You could even be getting hungry for your next meal before it hits you that you’ve forgotten to take it. All these scenarios are normal. Getting used to a mealtime insulin routine often takes some trial and error. The important thing is to stay committed to your current diabetes treatment plan and follow the advice of your doctor.

Take a look at some typical guidelines for what do when you miss a dose, based on when you realize it.

  • During the meal: Take your missed insulin dose at the end of the meal.

  • Within an hour of your missed dose: Take your missed dose, adjusted for the carbohydrates you ate.

  • At your next meal: Take your mealtime dose for this next meal and, if your blood sugar level is high, add the correction dose your doctor prescribed.

Taking Mealtime Insulin When You Can’t Eat

Flu, food poisoning, and food allergy reactions can all make it hard to eat. Work with your doctor on a mealtime insulin schedule for when you’re sick. Often, doctors recommend continuing the same schedule as if you were eating. Your insulin dose may even increase. Check your blood sugar levels often and keep the lines of communication open with your doctor, especially if you feel your levels are uncontrolled.

Here’s the big takeaway: mealtime insulin for diabetes isn’t just about the medication itself. It requires some education and planning, but it also helps keep controlling your blood sugar levels at the top of the priority list. Keep in mind you and your doctor chose your current diabetes treatment plan because you both felt it was the best one for you. Stay confident in your ability to see it through, but if it’s simply not working out, have an honest conversation with your doctor about that, too. Your doctor will have tips and strategies for sticking to mealtime insulin and can work with you to make adjustments if you need. If you take mealtime insulin as prescribed, learn how to make up for missed doses, consistently refill your prescription, and be honest with your doctor, you’ll be in control of your blood sugar levels and your diabetes.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Jun 6
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