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Handling Accidental or Missed Insulin Doses

By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Warning: Please work with your healthcare provider. Although the following suggestions may be common approaches to insulin dose adjustment, you want to be sure you are safe and under the guidance of a professional before changing your insulin regime. It takes time to understand these steps and to see how your body responds.

If insulin is a part of your diabetes regimen, life is certain to get in the way at least once and then you are faced with what to do when you have accidentally skipped an insulin dose. Here are some solutions to this common problem.

Missed Insulin Dose: Once-a-day, intermediate or long-acting insulin
If you missed your once-a-day, intermediate or long-acting insulin dose, and you realize it within 4 hours, the full dose can still be taken. If it's more than 4 hours late:

• calculate the number of hours late,
• divide by 24, and
• multiply by your usual insulin dose.

For example:
Let's say you wake up at 2 a.m. and realize you missed your 8 p.m. Lantus dose of 34 units.
1. Take 6 (hours late), divide by 24 (hours in a day) which equals 0.25.
2. Multiply 0.25 by 34 (units normally taken) and you get 8.5.
3. Subtract 8.5 from 34 and you get 25.5. You'd round down from 25.5 units to 25 units for safety.

You could then take 25 units of Lantus at 2 a.m.

Missed Insulin Dose: Twice-a-day, intermediate or long-acting insulin
If you missed your twice-a-day, intermediate or long-acting insulin dose, and it's within 4 hours, you can take the full dose. If it's more than 4 hours, skip that dose entirely and cover any high glucose levels with rapid-acting insulin.

Missed Insulin Dose: Mealtime dose of rapid-acting insulin
If you missed a mealtime dose of rapid-acting insulin and realized it within the hour, take your normal dose. If it's within 2 hours later, take 75 percent of your normal dose, and if it's 3 hours later, take half of your normal dose. If you use a personalized sliding scale, you can recheck your glucose and use a correction factor instead.

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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.