In this section
Glargine is a long acting insulin generally given in the evening, that provides the body with a continues supply of insulin. It lasts about 24 hours. If there is no glargine and you have not given rapid acting insulin (NovoRapid™ / Humalog™) within the past 3-4
hours, it is likely that your body will make ketones and is at risk of developing life threatening diabetic ketoacidosis (DKA).
If you are unsure if you gave your glargine you’ll need to regularly check your BGLs overnight. Ketones will need to be checked if your BGL is over 15 mmol/L. Without glargine, your BGL will start to rise as your dinner rapid acting insulin runs out (generally 4-5 hours after meal).
Ketones of 1.0mmol/L or higher with high BGLs would suggest your glargine is missed. If so, follow the advice below, and work out a plan to stop this happening again.
You might try ticking your record book once you have given your dose of insulin, using a white board or setting a phone reminder.
1. Check BGL and ketones
2. If ketones are less than 1.0mmol/L give 4
hourly rapid acting insulin (NovoRapid™/Humalog™) throughout the day and eat approximately 2 serves carbohydrate
(CHO) with each injection (the total CHO intake will vary depending on age and
normal meal size). Continue this until you give the evening dose of glargine
3. If ketones are 1.0 mmol/L or higher and
associated with any change to conscious state, severe headache, abdominal pain
or vomiting, give 10% of TDD rapid acting insulin immediately (see below) and
seek urgent medical attention. You might be in DKA
4. If ketones are 1.0mmol/L or more at breakfast:
5. If ketones are 1.0mmol/L or more and
breakfast will not be eaten
6. If you are unsure what to do after reading
the above advice, contact your treating diabetes team
10% of TDD given as rapid acting insulin = TDD÷ 10
4 hourly rapid acting dose to be given until glargine™ is recommenced = TDD÷ 6
Missed glargine, realised in morning
Waking at 8am with high BGL and ketones after missing an evening dose of glargine:
Total Daily Dose (TDD) = 5 + 8 + 6 + 15 = 34 units insulin
1. 10% of TDD is given as an additional rapid acting insulin
2. 4 hourly rapid acting dose
If well and willing to eat breakfast add 3.5 units to breakfast dose of 5 units = 8.5 units rapid acting insulin