A Game Plan to Remember to Take Insulin


Living with diabetes requires having a routine you can rely on to manage it effectively—whether it’s a reliable routine surrounding food, exercise, medication, or anything else that impacts your glucose levels.

For some, staying consistent with managing type 2 diabetes includes carefully monitoring when to take certain medications, such as insulin. But what happens when you accidentally miss a dose of insulin? Whether mealtime, long-acting, or both, remembering to take insulin is critical to maintaining blood sugar. Skipping insulin dosages can lead to high blood sugars, which increase the risk of diabetes-related complications, or accidentally taking more insulin than needed, which puts you at risk of hypoglycemia.

Still, missed dosages can happen because life gets in the way of putting yourself and your diabetes management first. This was the case for Vickie Nell, who’s been living with type 2 diabetes for over 20 years and has been using insulin for nearly 10 years. Vickie spoke with Beyond Type 2 about why she’d skip taking her mealtime and long-acting insulin, the impact it had on her health and how she rarely, if ever, misses a dose, now.

Missing Insulin Dosages

As for why she missed insulin dosages, Vickie explains, “I wasn’t always up for taking my insulin. I always had a reason—the insulin pen was too far away, I forgot to take it before I ate, or I felt like I just didn’t need it. My doctor would ask me how often I would take it and I would tell her once or twice a week. She’d tell me I needed to do it more often than that, especially when I’d eat, and suggested I come up with a way to remember to take it.”

When Vickie first started taking insulin, she was caring for her parents. She’d take her insulin occasionally, but for the most part, her parents were her priority.

“My own health was in the background,” says Vickie. “Then I lost them and was going through my own grief process. I didn’t want to take care of myself. My A1C was, at one point in 2013, 12.5 percent. I was suffering from migraines that put me in the hospital. I was one of the lucky ones because I didn’t lose my sight and I didn’t lose a limb. I just got migraines that are still constant today, but they’re at a level at which I can cope. But diabetes is one of those diseases that even if you say, ‘I don’t have to take insulin every day,’ at some point, that will catch up with you. So, I told myself I have to figure how to manage it.”

Vickie never double-dosed on insulin throughout the years she’s used it. If she missed a dose, she’d wait until it was time to take it again—usually around meals—and always injected a little extra to cover whatever she ate.

Having a Game Plan

So how does Vickie remember to take her insulin on a consistent basis, specifically at the right time or for the right meal? She uses a journal by Mary Van Doorn, the leader of the support group for women with diabetes called Sugar Mama Strong. It also helps that her doctor put her on a sliding scale, where Vickie could adjust the amount of insulin depending on her glucose levels or the number of carbs she’d eat. For Vickie, the biggest benefit to using a sliding scale to remember to take her insulin is that she doesn’t need to rely on calculating insulin-to-carb ratios or correction factors. Using a sliding scale simplifies her routine.

“My doctor and I have a game plan for everything,” said Vickie. “The sliding scale is one of the things we set up because I started exercising and losing weight. If my blood sugar is below 90 mg/dL, I won’t take any insulin unless I’m eating pasta or something else that’s going to spike it. If my blood sugar is between 90-100 mg/dL, I take four units of insulin. If it’s 150 mg/dL, I’ll take six. Basically, I increase my insulin by a certain number depending on how my blood sugar rises.”

Another way Vickie has remembered to take insulin is by putting her insulin pen right by her fork, so before she’d start eating, she’d inject. If she still forgets to take it before meals, her doctor told her she can take it up to an hour after, a tip that’s worked for Vickie if she goes out to eat but accidentally leaves her insulin pen at home. For her long-acting insulin that she’d inject at night, she’d keep it at her bedside—a simple, yet effective, change.

The plan has worked in Vickie’s favor. Though she describes living with diabetes as sometimes being yo-yo-like, filled with ups and downs, she’s been able to maintain some healthy habits and has seen her A1C decrease over time. Her latest A1C result was 6.7—a great accomplishment from her previous 12.5 percent from years earlier and despite the ups and downs it took to get there. She also credits her progress with the use of continuous glucose monitoring (CGM), which helps her see the impact her insulin has on her blood glucose levels.

“I’m eating better and exercising,” says Vickie. “I’ve been able to reduce my daytime insulin and nighttime insulin. Everything is going well.”

When asked if her routine has altered other aspects of life with diabetes such as her attitudes towards food, Vickie’s answer? Not really. In fact, she says even though she’s not very good at cooking, she has a pretty good relationship with food.

Staying Positive

Her positive attitude about her diabetes also extends to her thoughts about insulin stigma within the type 2 diabetes community. In her support group, women with all kinds of diabetes can have honest conversations about living with this chronic illness. Vickie has seen some of these conversations centers on the fear of using insulin to manage type 2 diabetes, specifically.

“When people ask about insulin, they’re scared,” says Vickie. “They think they’re a failure because their doctor wants to give them insulin and they don’t want to go on it. I tell them they’re not a failure. Insulin is a tool—a stepping-stone to help you get where you need to be.”

This content was made possible with support from Lilly Diabetes. Beyond Type 2 maintains full editorial control of all content published on our platforms.

WRITTEN BY T'ara Smith, MS, Nutrition Education, POSTED 12/13/21, UPDATED 10/04/22

T’ara was diagnosed with type 2 diabetes in July 2017 at the age of 25. Since her diagnosis, she focused her academic studies and career on diabetes awareness and living a full life with it. She’s excited to have joined the Beyond Type 1 team to continue her work. Two years later, T'ara discovered she'd been misdiagnosed with type 2 and actually has LADA. Outside the office, T’ara enjoys going to the movies, visiting parks with her dog, listening to BTS and cooking awesome healthy meals. T’ara holds an MS in Nutrition Education from American University.