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How Much Do Forgotten Insulin Injections Matter To Hemoglobin A1c In People With Diabetes? A Simulation Study

Go to: Forgotten or omitted insulin injections are an important contributing factor to poor glycemic control in people with type 1 diabetes. This study uses mathematical modeling and examines the impact on hemoglobin A1c (HbA1c) levels if insulin injections are forgotten. The simulation concerns people with type 1 diabetes on intensive insulin therapy. Five sets of blood glucose profiles with and without a forgotten injection were obtained. The difference to HbA1c was calculated using an HbA1c estimator on the profiles and was multiplied by the frequency of forgotten events. A frequency of 2.1 forgotten injections per week was found in the literature. Calculations showed that forgetting 2.1 meal-related injections per week would lead to an increase in HbA1c of at least 0.3–0.4% points, and similarly 0.2–0.3% points related to forgotten injections of the long-acting insulin. In case of even more pronounced nonadherence (e.g., if 39% of all injections are forgotten) there is a possible increase of HbA1c of 1.8% points. The magnitude of the possible improvement in HbA1c agrees well with other studies in the relation between adherence and HbA1c levels. The estimated numbers suggest Continue reading >>

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Popular Questions

  1. projector

    I'm a type 1, I usually take a long acting dose each morning and a short acting one with meals. Somehow I forgot the long acting this morning - this doesn't happen often, but it did today.
    I'm planning to take correction doses / extra units with my meals, do extra tests between meals, and possibly take an extra dose or two to correct.
    I wondered if anyone here could offer any advice to me? Or tell me how you've handled this?

  2. javellin

    a little high is better than a little low IMO. I'd just test often through the day and correct with fast acting as needed.

  3. Sideburnt

    Inject 50% at the next available opportunity, 75% at the next scheduled Basal and then back to 100%. This will re-introduce the Basal with only a little conflicting overlap, you can adjust any swing using Bolus. It's annoying but better than going a whole 24H without Basal, then another 24H for your Basal to become balanced.

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