Give your basal dose once a day. Seems easy, right? And yet, almost everyone who has T1D and has been managing it with MDI (multiple daily injections) for any length of time will make this error… if they haven’t already. It happens. Maybe you get interrupted while doing your basal insulin. Or Mom and Dad accidentally both gave kiddo their basal dose one evening. Maybe long-acting and rapid-acting insulins get mixed up at some point. Whatever the reason, it’s likely that one day you’ll find yourself in this situation. So, what should we do about it when it happens?
I am not a doctor or medical professional. This article is for informational purposes only. If you need medical advice, consult your diabetes team for assistance.
The good news
It’s called “long-acting” insulin for a reason. Basal insulins have a duration of 18-42+ hours, depending on the kind you use. Most of them don’t even start working for 4-6 hours. So, before you start panicking, take a breath. You noticed that an error was made and you have some time to figure out a solution.
First things first
I don’t want to gloss over the most important question. Are you sure that you doubled your basal dose or do you just think it might have happened?
It can be difficult to tell after the fact. Did you give the dose twice, or did you just think about it?
Giving basal insulin becomes quite a mundane task after a while and we tend to do it on autopilot. That, coupled with the fact that most people with T1D (or their caregivers) are sleep deprived, can make our memories a little foggy. Especially if you get interrupted in the middle of giving insulin, it gets really tricky to sort out what happened.
Mentally retrace your steps. Where were you when you thought about giving your basal dose? Did you pick up the insulin pen? Did you use a pen tip or syringe? Where did you get it from? Do you remember dialing up the basal dose? Which injection site did you use? How much insulin did you give?
Even after thinking everything through, you might not be 100% positive. That’s ok, you’ll just have to monitor a little more closely than usual to figure it out.
For now, let’s assume basal has been doubled. We can discuss what that means and what we can do about it.
Now let’s talk it through
I can’t stress this enough, I’m not a medical professional. That said, I am a human who can use logic. And so are you. But since you might be a little stressed about your current situation (I’m assuming you’re reading this because you’ve accidentally doubled your basal dose), let’s figure this out together.
We know what basal insulin does. It keeps bg steady in the background. So, when given correctly, if your basal dose is set accurately, you should be able to fast all day and have very little change in bg level. This means, doubling your basal will make your basal insulin pull your bg down.
So, we have to watch out for lows. Possibly prolonged, stubborn lows. Remember, this is likely to start occurring 4-6 hours after the second dose was given.
How much will it pull down?
This depends on the kind of basal insulin you use.
Take a moment to see what your basal insulin’s profile is. Does it have a peak? How long does it take to begin working? What’s the duration? These things all make a difference and knowing the details can help you predict what will happen when you’ve accidentally taken more than you meant to.
The duration is particularly important. That’s, more or less, the window of time that you can expect lows to happen due to doubling your basal dose. Once the duration time has passed, you shouldn’t continue to see negative effects.
It also depends on how much you accidentally took. If you usually take 10 units of basal insulin and you accidentally gave 11, that’s not going to affect your bg as much as if you had accidentally given 20 units.
Because of the long duration of basal insulin, even doubling the intended dose is usually perfectly manageable. This kind of insulin will pull bg down slowly over several hours, not suddenly cause a steep drop. But if you don’t feel comfortable managing at home, contact your diabetes team or another medical professional.
Proactive or reactive? How about both!
Since you know what to expect, there are several things you can do to counter the extra basal insulin. You don’t need to wait for lows to happen. Here are a few things you can do:
- Check bg more frequently. Especially if you’re doing finger pokes, increase the frequency. Set alarms if that helps you remember. And make sure you monitor your bg closely overnight. If you use a CGM, set your low alert a bit higher than usual. You’re expecting lows, so try to catch them before they happen.
- Eat the “difficult” foods. You know those foods that cause stubborn highs and are usually tricky to dose for? Those are your friends now. Protein keeps breaking down into glucose 5+ hours after eating it. And fat causes insulin resistance. If you’ve taken too much basal, those macros will help keep your bg up longer than carbs and sugar will. Pizza and ice cream! Yay!
- Go easy on your boluses. The extra basal insulin is going to cover some of your food for you. If you give the usual amount of insulin when dosing for food, it’s likely to cause lows.
- Have fast-acting carbs ready. You’ve caught your mistake and are being proactive. The goal is to avoid lows. But they still might happen. Make sure you’re stocked up on easy-to-access, fast-acting carbs like juice or candy. You may need to follow up with a protein snack to keep bg up once you’ve treated the low.
Oh, and it’s probably a good idea to be extra proactive and implement some of the tricks on this list so that you don’t end up in this situation again: Remember your Basal Every Time with these Simple Tricks
While it’s not ideal to accidentally double your basal dose
It’s not the end of the world either. As I mentioned, everyone with T1D does things like this at some point. So try not to feel bad, guilty, or embarrassed about it.
Life happens. Especially with T1D. We’ll fumble through the mistakes and hopefully learn from them.
Remember, even when it comes to T1D, most errors are not urgent emergencies. You can take a breath and think things through, contact your diabetes team, or look up information.
And every problem has a solution. You might be able to solve it at home on your own, or you might need help from medical professionals.
Either way, you’ve got this!
~ Leah
Have you ever accidentally doubled your basal dose? What did you do to manage the situation?
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