Diabetes mellitus requires a lot of self-care—diligently adhering to a diabetes-friendly diet, following your medication regimen, foot care, regular glucose monitoring, recognising the symptoms of high or low blood sugar levels, and making any necessary lifestyle changes.
Medications are one of the main components of keeping the blood sugar level in check, and it is important to stick to the prescribed dosage and schedule. However, there are times you may slip up and miss a dose.
Studies have shown that 36%-93% of people with diabetes have good daily medication adherence. In India, this amount is lower – only 47%-59%. In other words, as many as two out of every five people with diabetes miss their anti-diabetes medication dose.
Understand why you may miss a dose
There can be various reasons why you may miss a dose of your medication. Simple forgetfulness and a busy life are common causes, especially among those who are newly diagnosed and have not become used to taking their medicines regularly. Similarly, a change in food habits, a new job, or moving to a new city can affect your medication schedule. Another reason for missing a dose can be simply that you have to take many pills at different times of the day. Even though you have a pillbox with days of the week marked, you may not actually remember to open it at specific times of the day.
Finally, some people deliberately skip a dose or two, or delay refilling their prescription, because they “do not feel sick anymore” or because of financial constraints. Other reasons include not trusting the doctor or fear of side effects. [2, 3] It is important to realise why you miss a dose because you can take action to rectify this.
Why is missing your medication dose a problem?
Whether you miss a dose by accident or skip it intentionally, remember that good adherence to your anti-diabetic medication plan (whether sugar-lowering pills or insulin) is essential for long, complication-free life.
Missing a dose increases the blood glucose level. If your HbA1c level has been generally good, and you have followed the diet and lifestyle modifications well, then missing one dose may not be a problem. However, you should be aware of the symptoms of hyperglycemia.
Frequent missed doses lead to serious health complications, both in the short and the long term. You would have to visit the doctor, and even get hospitalized, more often, which also increases the overall cost of the diabetes treatment. 
What should you do if you miss one dose?
In general, for diabetes medications including oral hypoglycemic agents (e.g., metformin) and insulin, if you miss one dose, take the next one as soon as you remember it. However, if you remember close to the time of the next dose, then skip it and take the next dose instead. Do NOT double the dose.
It is recommended that you check with your doctor regarding your specific medication, however.
Strategies to avoid missing medications
As mentioned earlier, try to identify the reason(s) why you miss your dose and then take steps to resolve or at least minimise the cause. Some of them are as under:
- Planning meals: Irregular meal patterns disturb the medication schedule. Sticking to a fixed meal plan will also help you stick to the dosage.
- Fewer pills: If you take too many pills a day, talk to your doctor if they can reduce the number. This is sometimes possible by taking a pill that has multiple medications and/or by switching to pills that need to be taken fewer times a day (e.g., one or two times instead of three).
- Self-education: Get to know how your medications work, what the side effects are and how frequent they are, and the symptoms of high and low sugar level. Educating yourself about your disease and the medicines you are taking will help you considerably improve your sugar management overall.
- Third-party help: Being accountable to a “third party”—friends and/or family members—has been proven to be extremely effective in staying on track with the diabetes care plan. Tell them about your medicines and doses so that they can remind you if you have forgotten. But the chances that the very fact that you have told them about this will itself help you remember to take medicines regularly.
- Cheaper pills: Newer brands of medicines frequently enter the market, so ask your doctor if cheaper options for the medicines you have been prescribed are available. This will reduce your financial burden.
- Selfie medicine: Sending a photo or a short video of you taking your medicine to your doctor or your family or friends is a great way of ensuring that you do not miss your medicine. If your doctor does not have such a plan, ask your friends or family if they can support you here.
- Smartphone apps: There are over a thousand apps (both free and paid) specifically to help people take their medicines on time. They can give you periodic reminders via push notifications, SMS, email, and alarms. You can also set specific reminders, such as for refilling your medication box. Find an app that combines a lot of the strategies mentioned above — one that gives you a combination of reminders, educates you about your disease or medicine, involves friends or family, reminds you about refills, track your goals, etc. (An example of such an app is MyMeds). Some of these apps even gamify your progress, which makes medication management fun!
If you have missed doses of your medications, note this down and inform your doctor on your next visit. This is because if your doctor does not know about you missing your medication, then they may think the medicines are not working and unnecessarily change them or increase the dose.
- Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes care. 2004 May 1;27(5):1218-24.
- MuKherjee S, SharMaSarKar B, DaS KK, Bhattacharyya A, Deb A. Compliance to anti-diabetic drugs: observations from the diabetic clinic of a medical college in kolkata, India. Journal of clinical and diagnostic research: JCDR. 2013 Apr;7(4):661.
- Sapkota S, Brien JA, Aslani P. Nepalese patients’ anti-diabetic medication taking behaviour: an exploratory study. Ethnicity & health. 2017 Feb 25:1-9.
- Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabetic Medicine. 2015 Jun;32(6):725-37.
- Ahmed I, Ahmad NS, Ali S, Ali S, George A, Danish HS, Uppal E, Soo J, Mobasheri MH, King D, Cox B. Medication Adherence Apps: Review and Content Analysis. JMIR mHealth and uHealth. 2018 Mar;6(3).