Can you skip injection as T1 in some situation

[cp1024]

So, I was told years ago that you can never skip an injection you must always take something, but why?

For example, say Its lunch and i know afterwards im going to be physically active and i eat healthy in my case any amount of insulin and physical work and a small meal would not require insulin, realistically.

i usually end up taking something to stop hypo, even if i take say 4 units.

So i just wonder if in a situation like that is insulin doing something other than helping with the sugar, is it still required in that situation.

 

[Richard F]

I do skip sometimes, lunch is usually 2 units. If I'm a bit low beforehand I'll either take 1 or none, if need be I'll correct in a couple of hrs.

 

[EllieM]

So i just wonder if in a situation like that is insulin doing something other than helping with the sugar, is it still required in that situation.

It depends on your insulin regime. You always need some insulin in your system, even if you are asleep and fasting, so in that sense you cannot skip injections. If you are on a basal/bolus regime (long acting basal to cover your needs when you are not eating and short acting bolus to cover your meals) then you can't skip the basal, but you might well skip the bolus, eg if you skip a meal. You also might skip it if your blood sugar is low before the meal and you're not having many/any carbs in your meal.

You don't say how long you have been diabetic. If not long then you also may have the honeymoon effect going on, as your pancreas still produces some insulin. In this case you may also be able to skip insulin because you are still producing some of your own, but you'd need to discuss that with your doctor.

 

[urbanracer]

So, I was told years ago that you can never skip an injection you must always take something, but why?

For example, say Its lunch and i know afterwards im going to be physically active and i eat healthy in my case any amount of insulin and physical work and a small meal would not require insulin, realistically.

i usually end up taking something to stop hypo, even if i take say 4 units.

So i just wonder if in a situation like that is insulin doing something other than helping with the sugar, is it still required in that situation.

I was once told on a course that "your basal insulin can cope with about 20g of carbs" but this is a very misleading statement because there are so many variables.

20g of carbs and little or no subsequent activity would see my blood glucose soar into the high teens. If I was quite active afterwards then I might just get away without a bolus even though I'd likely be higher than I like to be.

Personal differences must be taken into account and there is no "one size fits all" solution to insulin management.

 

[Daibell]

As a T1 I assume you are on Basal/Bolus? You always need to take your Basal but you only need Bolus to match carbs in your meal. So, only take the Bolus when eating (or as a correction). Did you mean to say in your post that you take 4 units to avoid a Hypo? It should be taking some carbs to avoid a hypo as taking insulin might cause a hypo.

 

[ert]

I was once told on a course that "your basal insulin can cope with about 20g of carbs" but this is a very misleading statement because there are so many variables.

20g of carbs and little or no subsequent activity would see my blood glucose soar into the high teens. If I was quite active afterwards then I might just get away without a bolus even though I'd likely be higher than I like to be.

Personal differences must be taken into account and there is no "one size fits all" solution to insulin management.

Interesting advice from your course. I take very little basal insulin on my LCHF diet 2 to 2.5 units morning and night. If I break my diet with even small amounts of carbohydrates, my BS spike and run high, so I have to alter my FA ratio. So your comment explains a lot.

 

[UK T1]

Hi, to be very unhelpful (sorry!) I can only say it depends... but the posts above all help more!

Something not yet mentioned is your energy requirement for the exercise. So for example if you're usually on a low carb diet anyway, and let your basal insulin cover a meal before some exercise, just be careful that you don't end up requiring more energy than you're getting from your meals. If this happens you could end up breaking down fat and producing ketones as a result. Similar to 'starvation ketones' where your blood sugar may be in range but you have ketones present.
I don't know how dangerous these are in principle, and I guess it would depend on the level of ketones and how frequently you exercise and skip bolus? If it only happens rarely and you're drinking plenty of water and the ketones go quickly I don't know what danger there is really... maybe someone else can help?
Just thought it might be something to mention.

 

[Robinredbreast]

So, I was told years ago that you can never skip an injection you must always take something, but why?

For example, say Its lunch and i know afterwards im going to be physically active and i eat healthy in my case any amount of insulin and physical work and a small meal would not require insulin, realistically.

i usually end up taking something to stop hypo, even if i take say 4 units.

So i just wonder if in a situation like that is insulin doing something other than helping with the sugar, is it still required in that situation.

Hi, @cp1024, sometimes if I wake up on a 4 or a 5 I have no NovoRapid. Normally I only have 0.5 to 1 unit of Insulin with breakfast, so as long as I am active, which I normally am in the morning, I can get away with it, but I couldn't have lunch or a dinner without taking insulin.

 

[kev-w]

'Skipping injections' is an old diabetes term I think, from the old insulins when you went for the same timings and doses, for me these days my basal is essential but that'll hold me around where I want to be if I don't eat (give or take) so if I want to 'skip' lunch I don't inject for it same with work and exercise, doses change to suit, it's not a precision thing but if I'm the pancreas here I release insulin when I need it and not when I don't.

But then again I'm not the best pancreas mimic out there

 

[searley]

I miss the odd injection but the risk is going high...

But if your basal is right and you are going to be physical enough to use the glucose then yes you can miss/reduce

Just keep an eye on your levels as some people rise with exercise before they drop

 

[lizdeluz]

0805: 7.4mmol/L; 20g carbs; 4u bolus; 12u basal.
Set out on a walk.
0920: 6.6mmol/L;
10:20: 3.9mmol/L; 20g carbs; (4 Jelly Babies);
10:33: 3.7mmol/L; still walking; (2 glucose tablets.)
10:48: 4.9mmol/L
11:00: 7.2mmol/L; recovering with a coffee at home.
12:26: 10.4mmol;

I should have left out or reduced by half the bolus at breakfast in anticipation of the 5 mile walk.
I needed the basal at breakfast.
I always take hypo treatment with me, but it's better to think ahead to avoid a hypo if I can! Rather than cause the hypo and spike that happened this morning..
High-intensity anaerobic exercise can cause a rise in blood glucose. A gentle walk like mine, longish-duration aerobic, is more likely to cause a hypo, and it did.

 

[KK123]

Interesting advice from your course. I take very little basal insulin on my LCHF diet 2 to 2.5 units morning and night. If I break my diet with even small amounts of carbohydrates, my BS spike and run high, so I have to alter my FA ratio. So your comment explains a lot.

Hi there, the more common way of putting it is that if you eat around 15 to 20 carbs then you don't take any bolus (some still might have to of course). Of course as urbanracer says, that's because (generally) your basal can cope with that 15/20 carbs without bolus. If I go higher or lower carb over a few days I always have to alter my basal up or down to compensate. My understanding is that the two work in tandem with each other over the course of 24 hours, and although they do different things (fast acting and slow acting) there is also an average ratio between the two.

 

[Ushthetaff]

Hi I too was told you should never not take your insulin but that was probably over 30 years ago. The diabetic regime then was two insulin’s a day ( am & pm ) and meals at same time each day. Now it’s different . I miss injections quite regularly if I don’t eat a meal. I check sugars to make sure , but I find I’m fine , my long acting insulin seems to be the right dose . However when doing this I make sure my bs are well within range. But like everything diabetes is an individual thing and what works for me might not work for everyone .

 

[searley]

Hi I too was told you should never not take your insulin but that was probably over 30 years ago. The diabetic regime then was two insulin’s a day ( am & pm ) and meals at same time each day. Now it’s different . I miss injections quite regularly if I don’t eat a meal. I check sugars to make sure , but I find I’m fine , my long acting insulin seems to be the right dose . However when doing this I make sure my bs are well within range. But like everything diabetes is an individual thing and what works for me might not work for everyone .

I was told this too but only 10 years ago the problem is if you are going to have a lot of physical activity you can crash (I do) so then end up eating more to deal with it which is also not good.

If basal is right then the risk of DKA from 1 missed injection is minimal so long as care is taken to monitor BG’s

When at work I can have a very active day and can easily skip my lunch time jab my bg’s don’t rise and I do occasionally test for keytones and never have any... so for me it works

My advice would be try it if you wish, monitor and see if it works for you if it doesn’t don’t do it again