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Have you missed Insulin?

Have you forgotten to administer your insulin before your meal?
NovoRapid or Fiasp Tresiba/Degludec Lantus

Insulin Injection:

  • Can be given up-to 15-20 minutes after eating. 
  • If delayed beyond that, may need to reduce dose by 10 -20%, and be aware of possible hypo later. 
  • DO NOT use glucose in calculation as may overestimate insulin dose.

Insulin pump:

  • If it is within 30 minutes of eating: reduce meal dose by 10-20%
  • Within 30 minutes- 1 hour after eating: reduce meal dose by 20-50%
  • More than 1 hour after eating: Give correction dose as advised by pump bolus calculator. Do not enter carbs.

If delayed less than 4 hours: 

  • Give usual dose 

If delayed more than 4 hours:

  • Give usual dose even if in morning before breakfast
  • Ensure more than 8 hours before next dose

If delayed less than 4 hours: 

  • Give usual dose 

If delayed more than 4 hours:

  • Give half of usual dose even if in morning before breakfast

You will need to be aware of the increased risk of hyperglycaemia (high glucose level) and monitor blood glucose levels more closely.

Have you given too much Insulin?

Have you given too much insulin?
Or has your child not eaten the amount of carbohydrate you have bloused for?
Too much long acting given before bed Quick acting insulin given before bed instead of long-acting insulin Too much pre-meal insulin (quick acting)
  • Eat extra carbohydrate before bed.
  • Will need to check the glucose every 2 hours until the level is stable and has stopped decreasing. 
  • Hypo most likely at breakfast or later in the day. 
  • Listen out for CGM alarms. 
  • May need a reduction in dose of pre-meal quick acting insulin, 
  • Be vigilant with pre-meal blood glucose and insulin adjustment over next 24 hours.
  • Eat a large snack containing lots of complex carbohydrate e.g. oats, brown rice, whole wheat bread
  • DO NOT administer the basal insulin (long-acting insulin)
  • Check glucose levels every hour initially and treat any hypoglycaemic (low glucose level) episodes that occur appropriately, including easily absorbed glucose e.g. Lucozade, lift juice, followed by complex carbohydrates 
  • Once glucose appears to be stabilising check levels every 2 hours throughout the night
  • If the glucose level is stable by the morning give half the normal long-acting insulin and quick acting insulin appropriate for carbohydrate content of breakfast
  • Eat extra carbohydrate
  • Check insulin to carbohydrate ratio and use it to calculate how much carbohydrate you need to eat.
  • Check glucose hourly until stable. Listen out for alarms.

Remember: Call if you do not feel the advice above is working, or if your child feels unwell.

Have you noticed insulin leaking before or during administration?

Insulin Leaked during or after administration?

Insulin Injections: 

 Insulin Pump (HCL): Hybrid Closed Loop pump: 

Pre Meal Insulin 
(NovoRapid or Fiasp)

  • Monitor the glucose 2 hours post meal
  • Give a correction dose of insulin as necessary using the MyLife/ bolus advisor app or correction ratios.

Night-time long-acting insulin (Degludec, Tresiba, Lantus)

  • Glucose levels may run a little high the next day. 
  • The My Life app will suggest an insulin dose for meals including correction dose if necessary. 
  • Corrections to be given up to every 2 hours as required. 
  • If insulin is leaking you need to change the pump cannula/pod and giving set. 
  • Refer to ABCC flowchart and sick day rules if required. 
  • May need to administer a correction of insulin via the pen for ketones before carrying out set change. 
  • Please refer to sick day rules.
  • Usually, change the cannula before a meal in the afternoon/early evening to ensure you have time to check it is working well before bed. 
  • If they choose to change the cannula in the evening after dinner, it is important to advise them to check their blood glucose level 2-3 hours after insertion to ensure it is working.

As above, however family should be aware that any increased basal or corrections given by the pump may also have leaked and therefore IOB may be inaccurate. Monitor glucose levels closely over the next 4-6 hours. Do not override the pump bolus calculator if it is uncertain how much insulin has leaked.

Hyperglycaemia Management-High glucose level

Hyperglycaemia Management
(Glucose >10mmol/L)
High glucose without ketones Possible cannula/pod fail Illness and/or ketones present
  • No action required if it is within 2 hours of a meal.
  • Is the CGM accurate? Consider confirming high glucose with finger prick.
  • If it has been 2 hours since last meal administer a correction of insulin
  • Recheck glucose in 1 hour and if the same, or increased and using an insulin pump, refer to ‘ABCC’ advice sheet for further advice and guidance
  • If using insulin injections, please wait 2 hours before administering another correction
 If glucose is high and a correction of insulin has not decreased the glucose, please follow ‘ABCC’ advice sheet for further support and guidance Please use ‘Ketones and sick day rules‘ advice sheet for further advice and guidance

 Always consider:

  • Is the insulin working? (In date, not been exposed to sunlight, cold or hot temperatures)
  • If there is a pattern of high glucose levels, requiring correction doses of insulin, refer to ‘Top Ten Tips’ advice sheet for further advice and guidance. Contact the team if you require further support with this.
  • Type of food-if it has a high glycaemic index it can cause a high glucose initially, but it will come down without a correction 
  • Always check ketones if glucose is high for more than 2 hours following a correction of insulin, and/or unwell. 

Hypoglycaemia Management-Low glucose level

Hypoglycaemia Management
(Glucose <4mmol/L)
Glucose level below 4mmol/L Glucose below 4mmol/L and unwell Glucose below 4mmol/L without illness
  • Follow ‘Hypoglycaemia’ advice sheet for further instructions and guidance 
  • If symptoms do not match the CGM reading, confirm with finger prick
  • Follow ‘Hypoglycaemia’ advice sheet for further instructions and guidance 
  • Follow ‘Ketone and Sick day Rules’ advice sheet, for further advice and guidance
  • If vomiting and not able to tolerate fluids, try offering 10-20mls every 15 minutes, if still not tolerating, please contact the team as may need to be admitted for Intravenous fluids. 
  • Is there a pattern of lows at the same time each day? Your child’s settings may need changing, please follow ‘Top Ten Tips’ advice sheet and contact the team if you are unsure or require support with this.
  • Are you unable to bring the glucose back up above 4mmol/L despite several treatments? Confirm sensor is accurate by carrying out a finger prick and manual blood glucose check. If this is below 4mmol/L, contact the team urgently for support.

Please be aware:

If unconscious and/or fitting please place in recovery position, follow ‘Hypoglycaemia’ advice sheet for guidance of administration of glucagon injection and call 999

Alcohol Management

Is your child/young person unconscious or uncooperative or persistently vomiting?
Yes No

Unconscious or uncooperative: 

  • Place in recovery position
  • Call 999- explain that they have type 1 diabetes as well as being unconscious/uncooperative.
  • Check glucose level
    • If low go to page 6
    • If high go to page 7

Vomiting persistently:

  • Take them to A&E ASAP
  • Check glucose level
    • If low go to page 6
    • If high go to page 7

Glucose 10mmol/L and above

  • Monitor glucose hourly.
  • Ensure alarms are set correctly and are on the highest volume
  • Administer a correction of insulin
  • Re check in 1 hour
  • Glucose may drop later on
  • Follow advice on page on 6 as well as alcohol management.

Glucose 4-10mmol/L

  • Monitor glucose hourly.
  • Ensure alarms are set correctly and are on the highest volume
  • Consider setting the following overnight:
    • OmniPod 5: Activity mode 
    • CamAPS: Ease off
    • Tandem: sleep mode
    • Insulin injections, consider reducing the basal insulin before bed by 10-20% and/or eating a snack without insulin such as a slice of cheese on toast.
  • Consider sipping on Lucozade or hypo treatment to maintain glucose within target range (4-10mmolL)
  • Follow advice on page on 7 as well as alcohol management.

Alcohol affects blood glucose differently in different people. 
Because it contains carbohydrate it will usually make blood glucose rise whilst the young person is drinking it but generally glucose levels will drop later on.

Diabetes Technology

Diabetes Technology Technical advice:

Please call the relevant company to report or discuss 

  • Sensor and pod failures or replacements.
  • If there is a technical issue such as the sensor not picking up readings, or the CGM is not speaking to the insulin pump
  • If there is a discrepancy in sensor reading and blood glucose, but please first consider whether the glucose is dropping quickly as there is up to a 5minute lag. 
  • If you are unsure how to set up a new PDM/insulin pump, they will guide you through this, they will just need you to access Glooko to share the last pump settings.
  • If you have forgotten your username or password.

When to call the diabetes team:

  • Please call the diabetes team if the cannula/pod has failed and you or your child’s glucose level is high and you are not able to bring it down, and/or ketones develop and do not clear after using the sick day rules patient advice sheet.

Customer Services for CGM &Pump

Dexcom

0800 031 5763
https://dexcom-intl.custhelp.com/app/support_request

Monday-Friday: 7am-6pm

Saturday, Sunday & Bank Holidays: 8am-4.30pm
Abbot (Libre) 0800 170 1177
ADChelpuk@abbott.com

Monday-Friday: 8am-8pm

Saturday, Sunday & Bank Holidays: 9am-5pm
Omnipod 0800 011 6132
https://www.omnipod.com/en-gb/contact-us		 24 hours a day, 7 days a week.
Tandem 0808 196 7431
orderuk@tandemdiabetes.com		 24 hours a day, 7 days a week.
Ypso 0344 856 7820
info@mylife-diabetescare.co.uk		 24 hours a day, 7 days a week.
Medtronic 01923205167
https://www.medtronic-diabetes.com/en-gb/contact		 24 hours a day, 7 days a week.
Glooko 0207 7958191
help@glooko.com		  
My Life 0344 8567820
Info@mylife-diabetescare.co.uk		  

Insulin Supplies

If you do not have any insulin supplies left, please call 111 and they should be able to issue an emergency prescription for you.

Contact us

If you have any queries relating to this information, please contact the Paediatrics service.

About this information

Service:
Paediatrics

Reference:
P/113

Approval date:
1 May 2026

Review date:
1 May 2029

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Important note 

This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.