What to Do If You Forget to Take Lantus at Night

We’ve all had those moments of forgetfulness when our daily routines seem to slip our minds. Whether it’s forgetting to take out the trash or missing a dose of medication, these lapses can have consequences. If you’re someone who relies on glargine insulin, commonly known as Lantus™ or Optisulin™, it’s important to understand what to do if you forget to take it at night. Let’s explore some steps you can take to ensure your health and safety.

The Importance of Continuous Insulin Supply

Glargine insulin is a long-acting form of insulin that provides your body with a steady supply throughout the day and night. It lasts for about 24 hours, ensuring that your body has the insulin it needs to function properly. However, if you miss your glargine dose and haven’t taken any rapid-acting insulin like NovoRapid™ or Humalog™ within the past 3-4 hours, your body may start producing ketones. This can put you at risk of developing a life-threatening condition called diabetic ketoacidosis (DKA).

Unsure if You Took Your Glargine?

If you’re uncertain whether you took your glargine dose, it’s crucial to monitor your blood glucose levels (BGLs) overnight. If your BGL is over 15 mmol/L, it’s essential to check for ketones. A ketone level of 1.0mmol/L or higher, combined with elevated BGLs, may indicate that you missed your glargine dose. In such cases, follow the advice below and develop a plan to prevent this from happening again.

To help you remember if you took your dose, you can try ticking a box in your record book, using a whiteboard, or setting a reminder on your phone.

Remembered Before Bedtime

If you realize that you missed your glargine dose before going to bed, here’s what you can do:

• Take your regular glargine dose and return to your normal routine the next night.
• Check for ketones. If your ketone levels are 1.0mmol/L or higher, in addition to your glargine dose, take 10% of your total daily dose (TDD) of rapid-acting insulin. (The TDD explanation is in the box below).

Realized in the Morning

If you wake up in the morning and realize that you missed your glargine dose, here’s a step-by-step guide:

1. Check your blood glucose levels (BGLs) and ketones.
2. If your ketone levels are less than 1.0mmol/L, take 4 hourly doses of rapid-acting insulin (NovoRapid™/Humalog™) throughout the day. Additionally, eat approximately 2 servings of carbohydrates (CHO) with each injection. The total carbohydrate intake will vary based on your age and normal meal size. Continue this until you take your evening dose of glargine.
3. If your ketone levels are 1.0mmol/L or higher and you experience any change in consciousness, severe headaches, abdominal pain, or vomiting, take 10% of your TDD of rapid-acting insulin immediately and seek urgent medical attention. These symptoms may indicate DKA.
4. If your ketone levels are 1.0mmol/L or higher during breakfast:
   • Take extra rapid-acting insulin (NovoRapid™/Humalog™) to clear ketones with breakfast.
   • Add 10% of your TDD to the breakfast dose.
   • Check your BGL and ketones after 2 hours. You may need an additional 10% of your TDD (rapid-acting insulin).
   • Take the 4 hourly rapid-acting dose every 4 hours with approximately 2 servings of carbohydrates.

If you’re unsure about what to do after reading this advice, it’s best to contact your treating diabetes team for guidance.

Example Scenario

Here’s an example to help illustrate what to do if you missed your glargine dose and realize it in the morning:

You wake up at 8 am with a high BGL of 21.3 and ketone levels of 2.4 after missing your evening dose of glargine. In this case, you’ll need additional insulin. Your regular doses include:

• Pre-breakfast: 5 units of rapid-acting insulin.
• Pre-lunch: 8 units of rapid-acting insulin.
• Pre-dinner: 6 units of rapid-acting insulin.
• Glargine: 15 units at 8 pm.

To calculate your Total Daily Dose (TDD), add up your regular doses: 5 + 8 + 6 + 15 = 34 units of insulin.

Now let’s go through the calculations:

1. When giving additional rapid-acting insulin, take 10% of your TDD. In this case, it would be 3.4 units, rounded to 3.5 units if using a ½ unit pen or 3 units if using whole unit pens.
2. For the 4 hourly rapid-acting dose, divide your TDD by 6. In this case, it would be 34 ÷ 6 = 5.7 units, rounded to 5.5 units if using a ½ unit pen or 6 units if using whole unit pens.

If you’re well and willing to eat breakfast, add 3.5 units to your regular breakfast dose of 5 units, resulting in 8.5 units of rapid-acting insulin. Check your BGL and ketones after 2 hours. If your ketones are still 1.0mmol/L or higher, consider taking another 10% of your TDD as rapid-acting insulin and contact medical services if needed.

Continue with the 4 hourly rapid-acting dose for the remainder of the day, consuming approximately 2 servings of carbohydrates. Resume your usual insulin doses the following day.

Please note that this is general advice, and each person’s insulin plan may differ. The key points to remember are:

• Without insulin in your body, your BGLs and ketones will rise. If you miss your glargine dose, you must take rapid-acting insulin every 4 hours until you resume your glargine insulin.
• If you experience any signs of DKA, seek urgent medical care.
• If you’re unsure about what to do, seek medical advice.

For more information on various topics, visit 5 WS to explore the “5 WS” concept.

Remember, it’s essential to prioritize your health and follow your healthcare professional’s guidance to manage your diabetes effectively.