Insulin administration and the impacts of forgetting a dose.

purposeLittle is known about unintentional non-adherence associated with forgetting insulin injections and dose amounts. The study objective was to qualitatively examine unintentional insulin dosing and injection irregularities due to forgetting among people with diabetes mellitus.

methodsSeven focus group interviews and eight telephone interviews were conducted in Canada, Germany, and China. Participants were required to have diabetes, and to have experienced at least two instances in the previous 3 months of forgetting their insulin injection, forgetting the time/amount taken, or questioning if they had taken their injection. Transcripts were coded thematically, based on a grounded theoretical approach.

resultsSixty-four patients participated: 34.4 % with type 1 diabetes and 65.6 % with type 2 diabetes. The mean age was 50.1 years (range, 18-72 years). The analysis included six domains: Forgetting, what people forgot; Reasons for forgetting; Realizing forgetting; Corrective actions; Consequences of forgetting; and Feelings about forgetting. Participants reported forgetting both bolus and basal insulin doses and often felt uncertain about whether, when, and how much insulin they had taken. The major reasons for forgetting were disruptions to their daily routine, distraction by social events, minor interruptions, and being busy. Participants employed a wide variety of strategies and corrective actions when they thought they had forgotten, and often worried as a result.

conclusionsForgetting or questioning insulin dosing impacts insulin-taking behavior and contributes to patient uncertainty and worry about their diabetes management. Insulin strategies that assist patients in managing memory-related dosing issues may improve adherence or treatment outcomes.