I mistakenly injected the wrong insulin

[onnecar]

I have a sore eye and a bad leg at the moment, so struggling anyway. Also was distracted at lunch time and injected 10 units of my background insulin, instead of my fast novorapid fast-acting insulin. I normally inject 22 units of humulin in the morning, so now I have injected 32 units for today. I ate lunch but did not also inject the novorapid. Would be grateful for any advice at all. This is the first time I've made this mistake. Although once or twice in the past I have taken too much Novorapid or forgot to take it.

 

[SimonP78]

You might still need a bit of novorapid depending on what you're eating, but I'd be very sparing (and be tempted to err on the side of running high until you work out how much effect the extra insulin will have).

The biggest issue you may have is overnight as you'll likely tend to trend low and won't be awake to see it - you will probably need an uncovered bedtime snack and either set CGM alarm significantly higher than normal, and/or set an actual alarm to wake yourself up to do a blood test, and expect to need to wake up so have some options to hand.

See how you get on during the day, hopefully it'll be easy enough to control by eating with lower/no bolus cover.

I cross my fingers firmly, but haven't done this for quite some time - my MDI pens are different so it's hard to confuse them, but back when I used to mix my own short-ish and long-ish insulin (-ish because the older insulins were neither long nor short cf the insulins available today), I once took my morning dose (~45U total) instead of my evening dose (~15U total). It was a very long night eating stuff, wasn't much fun!

Please keep us up to date!

 

[onnecar]

Thanks for your answer Simon. I agree about the overnight thing. That is the most worrying side of it. I have a glucose monitor, but it's not infallible. I might do what you suggest about setting an alarm and eating huge bedtime snack. I don't sleep well anyway, so is going to be great fun and games. I will give myself lower humulin dose tomorrow probably too. Also keeping check on levels.

 

[SimonP78]

Is it Humulin I? Sorry I missed the mention of humulin and assumed, having seen mention of novorapid, that it would be one of the longer/flatter basals. My apologies!

If so, as it's peakier and shorter acting than more standard (for me as a type 1 basals), you may not have such problems overnight, but you may have more problems during the afternoon - I'd therefore try not taking any bolus at all (and see how you get on - if you do need to correct make it much smaller than normal.)

You shouldn't have any residual long acting by the morning, though it won't hurt to reduce the morning dose if you want to (the worst that will happen is you run a bit high all day) and it might also help if you end up running low during today as tomorrow will be spent (by your body) replenishing glycogen stores in the muscles and liver.

 

[onnecar]

Yes it is Humulin 1. I've noticed that my post lunch levels are in range but still higher than usual. So may have to take some novorapid at dinner.

 

[SimonP78]

How did you get on in the end? How was last night?

 

[onnecar]

Hi Simon. Sorry for being so long in replying. I can't seem to get on with the app on my phone, and find it easier to access the forum from my desktop computer. Didn't really have too many problems to be honest. I took some novorapid with dinner but a lower amount than normal and had a snack at bedtime, I think maybe I sucked a sweet too. Had no hypos and went back to my normal dosage the following day. Did run high for part of the day, so could have been a delayed knock on effect. I very often find that errors and changes have a way of working their way through, well after the event. I have a lot of other meds to take, so really have to keep an eye on what I'm doing. It's so easy to make a mistake. There isn't a hot line to contact anyone either. I've always thought that there should be one, just for advice if nothing else. Thank goodness for the forums.

 

[SimonP78]

No worries @onnecar, I'm glad it all worked out!

 

[grantg]

There isn't a hot line to contact anyone either. I've always thought that there should be one, just for advice if nothing else. Thank goodness for the forums.

your uk based, 111 is available to contact although waiting times can be long the forums here are a fantastic resource for highlands and isles alongside greater glasgow and clyde dsn's have a daytime number where you leave name&telephone number have found return your calls sometimes fast within hour, othertimes few days .. maybe you have something simular with your health board(s)?

 

[SimonP78]

It might amuse you to hear that I've managed to take, not the wrong insulin, but double the dose of my basal last night (for the first time ever while on MDI.)

Or at least I think I did - I have a piece of paper and biro in the pen case with my abasaglar and I always tick the day to say I've taken the dose - having the pen in situ means there is no reason that it doesn't happen, but I also log the data in XDrip+, which is what I usually look at.... (shame these pens don't have a memory - I know there are aftermarket caps, I may now have a look at them!)

I checked XDrip+ last night as I was getting into bed and apparently hadn't taken my basal, so dialled it up and took it without looking at my piece of paper, only to find that that evening had already been ticked when I went to tick the box....

Sure enough an hour later my hypo alarm went off, I ate 20g of fast acting (Skittles), went back to sleep, it went off an hour later, I ate more, thought about going back to sleep but was slightly concerned that my BG was dropping rapidly and was already <4mmol/l so I really needed to deal with it (which certainly woke me up!) I ate skittles as a stop-gap and then did a blood test to confirm, only to find that my Dexom One+ (which to date, 2x sensors, has been super-accurate when compared with blood tests) was under-reading substantially (GCM said 2mmol/l, fingerprick said 8mmol/l - and it wasn't just the lag, it was actually under-reading as I did more tests in the following ~hour before I decided I was ok to go back to sleep.)

I fiddled with hypo alarms and set them as low as possible so I could go back to sleep with that sensor (min alarm level = 2.3mmol/l + offset of 6mmol/l = 8.3mmol/l, I decided I could live with that as an alarm level and aiming to running higher overnight just to get through it with some sleep), decided that on balance I probably had taken the evening dose twice (I had my flu jab on Sat, and historically this has made me run low in the following days, I've also been trending low overnight generally over the last few weeks, so it's not cut and dried, it never is when you want it to be of course!) so I ate some cereal and went back to sleep and emerged unscathed this morning, though had to eat some uncovered carbs when I got up and have yet to take any basal or bolus (no FotF apparent).

My mistake wasn't as bad as it could have been re basal (would certainly have been much worse if I'd actually taken bolus instead of basal!), as I split 50-50% morning and evening, so I've only taken on-board an extra 1/2 of the total daily dose. I ended up eating 55g of uncovered carbs during the night.

I'll see what my BG does this morning, but will probably not do my usual basal this morning (or I might do a half dose) and then go back to normal this evening.

It would be nice if my Dexcom One+ started working again though, especially before tonight! - it's better, the offset this morning was only ~2.5mmol/l, so that will produce an alarm at a level that isn't too un-useful (2.3mmol/l alarm + 2.5mmol/l offset = 4.8mmol/l actual BG level for alarm.

 

[Antje77]

I have a piece of paper and biro in the pen case with my abasaglar and I always tick the day to say I've taken the dose - having the pen in situ means there is no reason that it doesn't happen, but I also log the data in XDrip+, which is what I usually look at.... (shame these pens don't have a memory - I know there are aftermarket caps, I may now have a look at them!)

What basal do you use?
Tresiba and Levemir can be used with Novopens with a memory for last dose.
Another pretty much foolproof trick is to use a 7 day pill organiser and put a pen needle in for every day of the week (or two if you split your basal). It's easy to dose and forget to log, equally easy to log and forget to dose, impossible to dose without using a pen needle.