I have a friend who’s newly diagnosed w/type 1 (LADA), after many years misdiagnosed as a type 2. She’s currently using Novolin R for meals and Novolin N twice a day for basal. She missed her morning 9AM dose and took it when she remembered at 2PM. What would you do about the usual 9PM dose in order to get back on track safely (and she doesn’t have a CGM)?
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This is tricky for me, because we find NPH squarely and peaky 
Is she on a CGM? I am guessing not.
My suggestion would be this: set up an alarm for midnight (10 hours after her last dose), take 3/4 of her regular NPH dose (less likely to go too high, and further away from her last injection), then take her regular dose tomorrow morning at 10:00am, and her regular dose the next time at 9:30pm. That is, if she can do this schedule.
I would look at the activation curve for N (NPH) and make sure to test frequently around peaking time.
I would suggest she take her dose a few hours later. The peak curves won’t hit each other, and she should be fine.
Since she was 5 hours late this morning, taking it 2.5 or 3 hours later than normal tonight should be fine. Since the peak is generally more than 5 hours after injection, this would be safe.
She can cut the dose a bit if she is worried about it.
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Sorry it took me so long to reply. I had not checked PMs.
Taking a rapid insulin close together can cause problems, but with a longer lasting insulin it is not as severe. Instead of 12 hours, doing 9 or 10 hours is not going to be too horrible. She can cut a bit if she wants and maybe have a small snack before she goes to bed if she is lower than she feels is safe.
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