Glucagon

glucagon-extinguisherThe red box.

I’ve shown it to coworkers. To family. To friends. I open the box up, show them the contents, and go through a complicated pantomime of what they would need to do. (Marcel Marceau is rolling in his grave. Silently, of course.) I had one staff meeting where my team played Rock Paper Scissors for who would use the red box. Make no mistake – it was the loser who got to administer it on me.

The red box is my glucagon kit and in all my years of T1, it has been used twice on me, and I was awake each time (although it was close). If you are having a severe hypoglycemic episode and can’t ingest glucose (because you’re unconscious or throwing up or can’t get another gram of glucose into you by mouth), it’s what’s going to help you.

It’s an insurance policy. The kits do expire and they’re aren’t cheap, even with a prescription, but it’s worth having – if you have someone with you who knows what the hell to do with it. It’s not a “take it and jab it into her butt and there you go” sort of deal. While you are incapacitated (and let’s be honest… if your blood sugar is 25, you’re not exactly spouting off the Declaration Proclamation verbatim, although you may think you are), the individual you trusted to use this kit must follow a set of directions that involves a few steps. It’s not like someone is going to rifle through your things and say…

“Hey, look! A glucagon emergency kit! Let me sit down and read the directions and get comfortable with this concept and figure out what to do…wow, there are a lot of steps… before I plunge a needle into your…”

If they don’t know what it is, what it’s for, what they need to do, it’s going to sit there.

So, here’s my challenge for you today.

If you have a glucagon kit, talk about it with the people who you love and hang out with you. If you have someone you work with that you trust, talk with him/her. I know that some people don’t want to disclose diabetes at work, but the last thing you want is to pass out and not have anyone understand why.)

  1. Show them where it resides (in your backpack, in the refrigerator, in your bedside drawer).
  2. Explain what it will do for you and what it won’t do.
  3. Tell them that you will do everything to avoid ever having to use this, but if it does need to be used, that you trust them to do whatever it takes to keep you alive – and it will keep you alive.
  4. Pull out the kit, go over the instructions, and answer any questions that they might have about it.
  5. Thank them. This is so important. Thank them for caring enough to help you if you can’t help yourself. It’s just as scary for them as it is for you when you are crazy low and/or unconscious.

 

I have an Eli Lilly Glucagon Emergency Kit for Low Blood Sugar. And you know what Eli Lilly did?

They made an app for the iPad and iPhone, giving you easy visuals to share and show – and prepare in case something does happen.

This is the website where you can get more info and click to download the app. I put it on my iPhone and it’s very easy to use:

www.lillyglucagon.com

app-screenshots

Until there are easier ways to administer glucagon (and there will be, because I believe that what is currently in clinical trials will become FDA approved – administered nasally versus intramuscular injection? Oh, yes.), it’s important that we give ourselves and those who are around us the tools and resources to help. (That nasal glucagon link? They are still recruiting, so you can help us all out if you are near a trial center.)

Now, what if you don’t have a glucagon kit?

Get one. Ask your doctor for a prescription and get one from your pharmacy. (Note: check the expiration date on the kit while you are standing at the pharmacy window. Do not accept a kit that has less than a year left to use it. Unlike some other supplies, this one will become less potent after the expiration date and because it’s expensive, don’t waste your money on a kit with just a few months left.)

As I said before, they are expensive and it’s one of the few things about my diabetes management in which I want to let expire.

Why do I tell you this?

I had a severe hypo a few weeks ago. Severe enough that I needed John to help me, because I could not longer use my legs to get more glucose. I was scared.

And after the disastrous event, both of us admitted that the red box was about a minute away from being used. If I hadn’t forced (and kept down) another juice box, it would have been a reality. I am thankful that I took the time to show John how it should be used and trust his judgement. I want everyone to be thankful. And everyone to have a red box – and never use it.

DAM: Diabetes & Hypoglycemia

243484_7519Ever overhear a conversation that included:

“Sorry I’m so cranky today. You know I’m hypoglycemic and my blood sugar must be a little low. Let’s go get a latte and a scone…”?

It’s usually followed by a hair flip and an application of shiny lip gloss.

That, my friends, is not hypoglycemia.*

People with diabetes know that insulin is not a cure. It’s what our bodies uses to bring glucose where it’s needed. (Remember the hot guy and the beautiful woman? That.) Too little insulin and we get sick. Too much insulin and we get sick. The very thing that keeps us alive can kill us. Not a pleasant thought, but one that needs to be understood when talking about hypoglycemia.

What is Hypoglycemia?

As simply as I can state it, it’s the lack of glucose in the blood. The brain (another really important organ to have) needs glucose to function, so if there isn’t enough of it floating around, the brain doesn’t work well. For people with diabetes, it’s easy to diagnose hypoglycemia – a blood glucose check does it. (Ahh… if only it were that simple, right?) Many medical professionals recommend the ingestion of some form of glucose when the blood glucose reading falls below 70 mg/dl, although some people with diabetes treat under 80 mg/dl.

What happens when blood sugars go lower than normal?

The body is an amazing machine. (Are you tired of me telling you this yet?) People with diabetes, despite having broken pancreases, still have other functioning bits. (Yes, bits is a medical term.) When there’s too much insulin and not enough glucose, two things happen.

  • The brain has a quiet freak out. (Technically, it’s called neuroglyceopenia.)
  • The body has a quiet freak out, releasing “counter-regulatory” hormones: adrenaline, glucagon, and epinephrine.

Symptoms are different for everyone – and they can change over time, but here are some of the more common ones:

  • Impaired judgment. (This is my downfall. While I may feel my blood sugar dropping, I have thoughts that include: “It’ll go back up by itself,” or “I’ll take care of it in a few minutes.” A few minutes is often the difference between a mild – easily treatable – hypoglycemic reaction and a moderate one.)
  • Difficulty speaking. 
  • Inability to control emotions. (I’m giddy girl going down. I think everything is hysterically funny and I often talk about my sock status. “Look! I’m not wearing socks!” Unfortunately, when I drop below 50 mg/dl, things aren’t funny anymore and I get angry, frustrated, and begin to get emotional. Academy Award winning performance.)
  • Sweating, shaking, pounding heartbeat (Thanks, hormones!), clamminess.
  • Vision issues, including blurriness or “tunnel vision”. (If I’m tunneling, as I call it, I’m in dire straits. It’s happened a few times and those few times called for glucagon or syrup administered on the sides of my mouth.)
  • Sleepiness. (I’ve caught myself tilting my head back and closing my eyes, thinking that I’ll just take a quick nap and I’ll feel better or rolling over in bed at night.)
  • Not being able to focus on anything. That’s how John can tell before I can that something is not right. He’s my human CGM, because he’ll ask me to check my blood sugar if he recognizes that I’m not “right”.
  • (A personal few symptoms that I have: my lips and the area around my mouth get numb and my hearing changes. When my hypo is horrible, I also can’t stop jerking my limbs and shaking uncontrollably because my body is trying to physically squeeze any glucose it can out of my muscles.)

I’m not a medical professional, so I can only tell you my own personal experiences with hypoglycemia. My “mild” lows are ones that I catch above 60 mg/dl. I usually bounce back quickly and the rest of my day isn’t impacted. “Moderate” hypoglycemia for me  hits around 50 mg/dl and if I can treat it immediately before it gets worse, while it will make me sluggish and one step behind for the rest of the day, I’m not down for the count. “Nasty” hypoglycemia for me is 40 mg/dl and under and it wipes me out for about 24 hours.

How Do You Treat Hypoglycemia?

How the experts say you should treat it:

Simple carbohydrates. Glucose. Rule of thumb is 15 grams of carbs, wait 15 minutes, then test. If you’re still below 70 mg/dl, then consume another 15g of glucose and wait another 15 minutes.

How I treat a mild low:

Glucose tabs. (I love Cherry Glucolift). Or juice. I wait 15 minutes, test, and then go on from there.

How I treat a low below 50 mg/dl:

Eat everything sweet that I can get my hands on because my brain is in full blown freak out mode. Wait what seems like 15 minutes (In reality, it’s about 45 seconds.) and then eat some more. Once I’m back above 70 mg/dl, I deal with the aftermath.

And when it’s low, low, low… this is how it happens. (It’s an oldie, but a goodie.)

Glucagon

Things can get dicey. If a person with diabetes can’t swallow anything, passes out, or is so ill that they can’t keep anything down and blood glucose is dropping to dangerous levels, it’s time to call in the big guns: external glucagon. Available by prescription, it’s a kit that uses a syringe to inject glucagon inter muscularly (IM) to force the liver to release sugar. (Again, that’s the non-medical explanation.)

I’ve had glucagon injected twice in thirty years and both times, I was conscious and consented for it to be done. My blood glucose levels were dangerously low and I was so nauseous that I knew I wouldn’t be able to ingest anything in time.

It’s not simple to use. Wish it was. You need to inject water into a vial of powder, shake it up, draw the liquid out, blah blah blah. The instructions and more information can be found here.

People can be freaked out when you talk about using it in the case of an emergency. I give a quick tutorial to coworkers and close friends and family (and refreshers) and let them know where I keep the kit in my purse. But I always tell them this: “Please make sure you call 911 immediately after you inject the glucagon. Please.” I hate the aftereffects of a glucagon injection (wicked nausea and gastrointestinal stress), but I hate the alternative more.

The Scary Thing I Don’t Want To Mention, But Will Because It’s Important

You can die from hypoglycemia.

The brain needs glucose to function. I don’t have to draw a picture for you. No glucose = no brain function.

I’d like to talk about it more, but I can’t. Not because I can’t find research or statistics, but because I…can’t.

It happens. It’s horrible. And it’s no one’s fault. We do everything we can and people with diabetes still die from insulin; the same drug that keeps us alive.

What Can You Do To Prevent Hypoglycemia?

I didn’t want to leave this post on a total downer, so here things you can do to prevent hypoglycemia:

Monitor:

  • What you eat
  • What you drink
  • What your blood glucose levels are
  • How much you exercise
  • How much insulin/medication you take

Wait… this sounds like… what most people with diabetes already do?

Yes. It’s because this disease is sometimes often unpredictable.

I  wear a CGM, check my blood glucose levels often, stay vigilant… and it still happens.

So, latte and scone lady?  You don’t know hypoglycemia. You don’t know cranky. And you certainly don’t know my sock status.

“Look! I’m not wearing any socks!”

* Yo, before you all get your pitchforks, there are individuals who do not have diabetes, but are clinically diagnosed with hypoglycemia. I know that. I’m talking about those individuals who think that because they don’t eat properly (a latte and three bites of lettuce is not lunch) and self-diagnose hypoglycemia are…well, you got to eat something besides lip gloss. Work on that, will ya?