Insulin is an effective medication for type 2 diabetes mellitus. However, to get the most out of your insulin injections, it must be taken in the prescribed doses at the scheduled times. Many patients skip or mistime their insulin dose. (1) People who skip doses or change times often have higher A1C levels as well as higher rates of hospital admissions for diabetes-related complications; this is in comparison to those who meticulously maintain their insulin regimen. (2)
Simply put, an erratic insulin regimen reduces the benefits you can derive from it. Therefore, your glucose control over time will not be as good as it could on a timely regimen.
Missing one dose
If you miss one dose of insulin, your blood glucose levels will rise (hyperglycemia). This rise might be small and not noticeable. However, patients may experience one or more of the following symptoms due to hyperglycemia:
- Increased thirst
- Frequent urination
- Confusion, lethargy, tiredness or drowsiness
- Feeling nauseous or vomiting
- Loss of appetite
- Dry and/or flushed skin
- Increase in heart rate
It is rare to get diabetic ketoacidosis (fruit smell on your breath), which could be a medical emergency.
Missing doses every once in a while or taking them irregularly
HbA1c: Poor glucose control (measured using HbA1c) puts a dent on successful long-term diabetic management. Studies have shown that those who never missed insulin doses are more likely to have excellent glucose control, as much as 25%, (3) whereas missing doses can increase the HbA1c by 0.5-1.5% higher than what it could be with regular, timely doses (1, 3, 4).
Long-term complications: Less than ideal blood glucose levels may not affect you immediately, so it may be easy to ignore the consequences. But over the long run, they considerably elevate the risk of diabetic complications. Complications of diabetes are numerous and range from skin ulcers to blurred vision to heart attacks. (4) You can check out the various complications of diabetes here.
Quality of life: These conditions affect your daily life more than the management of diabetes alone. They may affect your physical activity, increase the number or frequency of pills you need to take, impair your sexual life, and/or impact your social life. For example, you could face excessive sweating or toilet use when you’re with company.
Hospitals and bills: Poor glycemic control increases both the number of visits to the doctor and hospital admissions. (4) You might also be required to take blood tests at a higher frequency. Not sticking meticulously to an insulin regimen can also turn out to be more expensive in the long run.
If you tend to miss doses because of some reason or the other, talk to your doctor about the options available. (Read our article on insulin fears.) Longer-acting insulin, apps with reminders, and pill organisers are a few of the various strategies that you can use to adhere to your regimen. Investing a little time and effort now will ensure that you are a much healthier person, even with diabetes, a decade later!
- Josse RG, Woo V. Flexibly timed once‐daily dosing with degludec: a new ultra‐long‐acting basal insulin. Diabetes, Obesity and Metabolism. 2013 Dec;15(12):1077-84.
- Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes care. 2010 Feb 1;33(2):240-5.
- Jaser SS, Datye KA. Frequency of missed insulin boluses in type 1 diabetes and its impact on diabetes control. Diabetes technology & therapeutics. 2016 Jun 1;18(6):341-2.
- Sarbacker GB, Urteaga EM. Adherence to insulin therapy. Diabetes Spectrum. 2016 Aug 1;29(3):166-70.