# Forgotten to take Levemir



## Monica (Jun 21, 2010)

Oh dear!!!!
C forgot to take her Levemir last night.
She woke me during the night saying she was hypo. Tested 23.4. So we thought that the liver kicked in. This morning she came into my bedroom and said she didn't feel well. As soon as she said that, I asked her about the Levemir. She felt really upset that she'd forgotten. And I felt a bit bad that I hadn't reminded her as usual.(Usually, she had already done it when I asked).

Anyway, I hope I've done the right thing (too late to worry about it now though) I gave her half the dose of Levemir and 3 u NovoRapid. Then I got the book out to see what I should have done. In the book it said to give half the dose of Lantus, but mentiones nothing about Levemir. And 0.1U/kg bodyweight of Fast Acting.

Her sugar levels slowly came down to 13. But she had ketones. She had breakfast and I nagged her to drink to get rid of the ketones. By lunchtime she was 18 again, but her ketones have gone down (not completely disappeard yet).

I will make her test again in half an hour to see what her levels are 2 hours after lunch.

So I just wondered, what did you do if you forgot your Levemir?


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## everydayupsanddowns (Jun 21, 2010)

Hi Monica

Well done for your good guesswork! Forgetting doses is a nightmare, but it happens to all of us.

I'd say you got it just right. Last time I forgot basal (a month or two ago) I did jst the same. Half the forgotten basal dose, plus a bit of bolus correction and a hatful of BG tests over the day to see how things were going. 

Found I needed to slightly adjust my usual carb:insulin ratio too, but it all settled back easily enough the following day.


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## Monica (Jun 21, 2010)

Just tested again, it was 13!!


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## everydayupsanddowns (Jun 21, 2010)

18 -> 13 2h after lunch sounds quite promising (though not ideal obviously!) Lunchtime Novo should still have some legs left (depending on how long C finds its activity profile lasts for her - we're all different). 

I'm afraid it will be a question of lots of BG tests till it settles down


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## Monica (Jun 21, 2010)

Let's just hope she's not 18 again at dinner/teatime


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## Akasha (Jun 21, 2010)

My partner is on Levimir, and when he forgot to take his, I believe he near enough doubled his Nova rapid doses at food time. 

Not Ideal, and wouldn't recomend doing this for a child. 

TBH, it would never have crossed my mind to inject half of long acting...


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## everydayupsanddowns (Jun 21, 2010)

@Akasha My thinking went like this...

The hours that have passed without basal (and high consequent high bg) I can't do anything about, but I would like some basal until my next regular injection is due. 

Now given that most basals are reported to take 2-3 hours to get going and last 12-24+ hours depending partially on dose and partially on your own response (with Levemir typically 12-18ish hours) I figured the best bet was a half dose to cover the half-day of basal. My hope was that there should not be too much of the half-dose left to overlap with my next regular injection and add overnight-hypo-risk into the mix!

Recovering after a missed basal is never going to be easy :/


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## Monica (Jun 21, 2010)

Oh nooo, 15 this time. BUT we had risotto for dinner/tea, that usually makes her slightly higher than before the meal. She was 13 then. Haven't corrected it, as she'll still have Levemir in her body (hopefully) and will have some more in a minute.

This is horrible and hopefully won't happen again for a loooooong time!!

Well, I guess that's put the kybosh on a good HbA1c next week.


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## Northerner (Jun 21, 2010)

Monica said:


> Oh nooo, 15 this time. BUT we had risotto for dinner/tea, that usually makes her slightly higher than before the meal. She was 13 then. Haven't corrected it, as she'll still have Levemir in her body (hopefully) and will have some more in a minute.
> 
> This is horrible and hopefully won't happen again for a loooooong time!!
> 
> Well, I guess that's put the kybosh on a good HbA1c next week.



I shouldn't imagine that one day's poor levels will make much difference to the HbA1c. Let's hope that the next time you realise you've forgotten is so far in the future that it won't matter because she'll have been cured for ages!


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## Monica (Jun 21, 2010)

Northerner said:


> Let's hope that the next time you realise you've forgotten is so far in the future that it won't matter because she'll have been cured for ages!



Thanks Northerner, that made me smile


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