title: Insulin administration and the impacts of forgetting a dose.
abstract: OBJECTIVE
  Little 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.
  
  
  METHODS
  Seven 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.
  
  
  RESULTS
  Sixty-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.
  
  
  CONCLUSIONS
  Forgetting 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.
authors.affiliation: The Brod Group, 219 Julia Avenue, Mill Valley, CA, USA, mbrod@thebrodgroup.net.
authors.forename: Meryl
authors.initials: M
authors.lastname: Brod
authors.forename: Betsy
authors.initials: B
authors.lastname: Pohlman
authors.forename: Jens Harald
authors.initials: JH
authors.lastname: Kongsø
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D017144:Focus Groups; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin