What Happens if You Miss a Basal or Bolus Insulin Dose?

If you take insulin, you know that diabetes isn’t an easy disease to manage. You also know that it is sometimes possible to miss a bolus or basal insulin dose

You also know that missing a dose of basal or bolus insulin doesn’t make life any easier.

Taking insulin is a very important aspect of diabetes management. Despite being on top of taking your insulin, chances are—at some point or another—that you might miss an insulin dose—whether that’s because:

• You ran out of insulin, or
• You simply forgot to take your insulin

What is the Role of Insulin in Managing Blood-sugar Levels?

Insulin is a hormone that helps regulate blood-sugar levels. It does this by:

• Helping glucose move from the blood to the cells for energy.
• Signaling the liver to store glucose for later.

When insulin doses are missed, blood-sugar levels can increase.

Hyperglycemia occurs when blood-sugar levels are above 160 mg/dL.

Furthermore, ketone levels—which are associated with high blood-sugar levels—can increase when there isn’t enough insulin available

In addition to understanding what can happen to your blood-sugar levels when a dose of insulin is missed, it’s important to know what to do in this situation.

Here’s what can happen when you miss a dose of insulin—whether it’s basal or a bolus.

What Do I Do If You Miss a Dose of Basal Insulin?

Long-acting insulin—such as Basaglar, Lantus or Levemir—is also known as basal insulin.

Long-acting/basal insulin acts differently than short-acting insulin because it works in the background to keep blood-sugar levels in range for 24 hours.

However, when a dose of basal insulin is missed, there are steps to take depending on how late you are taking it.

First things first—Don’t panic!

If a once-daily basal-insulin dose is being given within three or four hours of when you usually take it, you can simply take it late.

However, if it is outside that window of time, give half your normal dose and take your full dose at your regular time.

This—of course— will require you to keep a close eye on your blood-sugar levels in case they are out of range due to the missed full dose.

Some people who take basal insulin split their doses in two. If one of your doses is missed, monitor your blood-sugar levels closely and give the usual amount when it’s time for your next one.

What Do I Do if Both Basal and Bolus Doses Are Missed?

While a basal dose involves long-acting insulin, a bolus dose involves short (rapid-acting) insulin.

Rapid-acting insulin starts working within 15 minutes, and stays in the body for up to four hours.

If you miss a bolus dose before a meal or snack and have already eaten, you can take insulin up to an hour after you’re done eating.

However, you will need to closely monitor your blood-sugar levels because taking insulin after eating can cause hypoglycemia, or low blood sugars.

This is because the insulin’s peak action will happen after most of the food has been digested.

Follow the above advice if a basal dose is missed.

In short, take your dose late if it’s within three to four hours of when you normally take it. If more time has passed, give half your usual dose and return back to your normal amount at your regular time.

If you take two doses per day, regularly check your blood-sugar levels and give your usual amount when it’s time to do so.

What Should I Do if a Dose is Missed on My Insulin Pump?

Insulin pumps can make diabetes management easier for people who take insulin.

However, there is a reason why you might miss a dose on an insulin pump—but not with shots. That reason is—Because you need to disconnect from an insulin pump when you shower, bathe or swim.

Insulin pumps are programmed to give you a certain amount of insulin each hour, which acts like basal insulin.

If you know you will be disconnected from your pump for about an hour, it’s a good idea to give a dose of insulin to cover the amount your pump is programmed to give.

However, you’ll need to take other factors into account, such as exercise and your blood-sugar levels.

Today, insulin pumps come with bolus calculators. Tandem’s Control-IQ system can calculate correction doses if a dose is missed to decrease blood-sugar levels more quickly.

Similarly, OmniPod’s SmartAdjust Technology responds to high blood-sugar levels by increasing insulin every five minutes until your BGL is back in range.

Managing Diabetes is Full of Highs and Lows

If you realize you’ve forgotten to take a dose of insulin, don’t panic.

Stay calm and follow the protocol for what to do in this situation.

And if you’re looking for a tool to help you remember to take your medication, check this one out.

This content was made possible by Lilly, a Founding Partner of Beyond Type 2.

Beyond Type 2 maintains editorial control over its content.