If You Take Insulin, Why Do You Need Glucagon?
Editor’s Note: If you take insulin or any other blood sugar-lowering medication, you need glucagon. Learn about your options here. For help with insurance coverage or payment, visit our glucagon resources page here.
Did you know there are multiple new and easy-to-use types of glucagon available these days? Used to raise blood sugars to safe levels during a severe low blood sugar (hypoglycemia) emergency, glucagon is now available as an auto-injector, nasal spray, or in a pre-filled syringe. Copay cards and Patient Assistance Programs (PAPs) are available to help with the cost.
To talk about all of the new options, a few members of the Beyond Type 1 staff who live with or are related to people with diabetes got together to chat.
Partial transcript of the conversation below, edited for content + clarity.
Lala: Hi everyone, my name is Lala. I’m on the content team here at Beyond Type 1 and I’m joined by some of my fantastic teammates who are either living with diabetes or related to folks with diabetes, because today we’re going to talk about glucagon.
There’s some amazing new glucagon options on the market these days that we know not everyone knows about. So we’re going to talk about what glucagon is, why you should go ahead and get a prescription if you need it using one of the copay cards that are available from all the different manufacturers. And then we’ll talk a little bit about our experiences with glucagon.
For my experience—I was diagnosed with type 1 diabetes when I was 10, almost 25 years ago. I almost never had glucagon on me when I was first diagnosed because the old glucagon scared me, it was a little bit hard to use, it had a big needle, I didn’t like it. Now with the new glucagon options that are available, I now carry glucagon with me all the time.
We want to let you know that if you use insulin, you do need to be able to carry glucagon with you as well. Insulin has the possibility of lowering your blood sugar to a dangerous level. If you accidentally take too much, or if something else happens, you’ve exercised your blood sugar can go too low. Glucagon can counteract that and make sure that you don’t end up in a dangerous situation because of severe low blood sugar.
I’d love to pass it over to my colleague, Eugenia. She comes to us from Mexico, she’s now living in the states, so she’s had lots of different experiences with glucagon and where it’s available.
Eugenia, can you tell us a little bit about your experience having glucagon on you now and why you know it’s so important to have?
Eugenia: Glucagon is something that you have to have, but hopefully you won’t use it. In my experience, I’ve never used glucagon, but me and my husband have diabetes, and we both use insulin.
So we train our son—he was younger when we showed him how to use glucagon, but it was the old kind. It was hard because he tried to understand how to use it and we had to try to trust him about that. Now it’s easier because he is 16 now and we have the nasal glucagon, so it’s easier.
We carry it everywhere, we have it in the bedroom, we have it in the bath, we have it everywhere because we know that hypoglycemia can happen anytime and it’s important to be prepared.
It’s like the insurance of the car, you have it, but you don’t want to use it.
Lala: I love that. It’s just like having insurance—you don’t want to use it, but if you need it, it needs to be there.
Ginger, I’d love to turn it over to you about your experience with glucagon and the different times that you’ve had to think about using it or have had to use it over the years.
Ginger: I think of glucagon as something that you could go two decades without ever needing, but when you really need it, you’re going to wish you had it if you don’t.
My personal experience with glucagon—I’ve never been unconscious during a low, but I have had two different stomach virus experiences, which is not something you necessarily think of as associated with severe low blood sugars. Usually, we think of viruses causing high blood sugars, and dehydration and diabetic ketoacidosis (DKA).
But one of my stomach viruses, I just ate Thanksgiving meal and then puked up three hours later, all the food I ate, but all that insulin was still in my system. And so I actually used the really old school Emergency Glucagon Kit. It worked, it did its job, my blood sugar did go a little too high, but I did not have a severe, scary, low blood sugar.
The time I wished I had glucagon when I didn’t was when I was eight months pregnant. I got norovirus, same situation had just eaten a large holiday meal, puked up everything, had so much insulin on board because I was eight months pregnant.
We ended up driving crazy fast to the emergency room that was a half-hour away, I lived in the woods. And it would’ve been really nice to have glucagon during that situation, it would’ve calmed everybody down. I couldn’t even keep a glucose tab down without vomiting more. I could not touch any food or drink item, and you don’t realize that’s possible until you are that sick and glucagon would of been very helpful.
Lala: I’ve definitely been in those situations where glucagon would’ve been helpful and to your point, I never had a severe low until 20 years in of living with diabetes. Now I get them a lot and it’s a little bit worrisome—it’s two or three [seveve lows] a year that are rough. I’ve definitely been in the situation where I’m sitting on my couch pouring honey into my mouth, but luckily I do now have glucagon sitting next to me, and I know if I feel like I’m about to cross over to a dangerous point, then I have something that could save my life. It’s scary to think of perhaps sitting in your apartment alone or anything like that, and not having glucagon if you need it.
Ginger: Right. I now keep glucagon with me and I carry it mostly in my dog-walking bag, where I feel I could be at most risk for a super low, and Skittles aren’t going to cut it.
Lala: So when it comes to options—there are two auto-injectors available, one is called Zegalogue®, one is called Gvoke HypoPen®, and then there’s the nasal spray Baqsimi®. The auto-injectors work just like EpiPens, where it’s just the real simple injection into your stomach, your arms, or your thighs. You just inject it and you hold it down and it gives the full dose automatically, which is so cool, and it’s so great to have something that’s so easy to use these days.
I want to toss over to Todd cause I know he shares Ginger’s and my experience of wishing he had it and not having it at the time.
Todd: So I have been living with diabetes now for 21 years, I was diagnosed when I was 13 in 2000. This incident happened in 2010, at the time I was still using syringes, I didn’t have a continuous glucose monitor (CGM) and I accidentally gave myself the wrong type of insulin.
I think many people have heard of this happening or maybe done it themselves, where I was supposed to give my long-acting insulin, but I gave myself rapid-acting insulin, 14 units of Humalog. This was about 10:30 or 11:00 at night and I did not have glucagon with me. I might have had an expired kit at my mom’s house, but I was living with my dad at the time.
My blood sugar was in the 40’s and 50’s for I think two or three hours. I actually ran out of low snacks, so I filled up a cup with water and poured granulated sugar in it, and drank that. Eventually, hours later, maybe 4:00 AM, my blood sugar was up in the 22.2mmol/L400mg/dL‘s. And I felt good about that, I was finally able to go to sleep. If I had glucagon at the time, especially one of these newer glucagons, I definitely would’ve used it. I don’t even think my dad was home that night, I think he was out.
I guess it is important to note that technically according to the FDA, you’re not supposed to self-administer glucagon, it’s supposed to be administered to you when you’re unconscious. In practice, we know that many, many people with diabetes, in fact, more often than not, are administering it to themselves.
Even if it’s not an approved use, it’s a great thing to have around and it could be a lifesaver. I have all of the new glucagons. Hopefully, I won’t need to use them, but I would definitely feel a lot better using them than being in a similar situation where I’m just panicked and worried I might die.
Lala: For sure. Just like Eugenia mentioned, having them in multiple places, I think that’s why it’s also so useful that there are multiple options available now. You can get different prescriptions filled, you can use different co-pay cards so that the cost can be as low as it can possibly be on different versions of insurance and such.
I think one of the reasons I really like that there are different options available is that it’s also really easy to share with your friends and family how to use it these days. I know when I first got my new glucagon prescription, I went on my Instagram stories and shared there how to use it, and that it would be always be in my bag and really simple to use.
Ellen, I would love for you to share your experience as someone who doesn’t live with diabetes, but loves people with diabetes, of learning how to use glucagon and why you know it’s so important and how it’s changed having the different options available.
Ellen: I don’t have diabetes under my roof right now, but we have five type 1’s in our family. I’ve always tried to keep myself aware of how to administer glucagon because like what Todd said, you’re not supposed to be administrating this to yourself and I would assume, being nondiabetic, that if somebody needed this they would be in such a state that they probably shouldn’t be administering it because they would get it wrong.
In the past I had known of glucagon is something you had to mix and you had to inject a certain way. I had my little instruction sheet and it was very confusing, and sort of scary to somebody who’s not living with this, who doesn’t do injections every day, to think I could really, really hurt this person if I did it wrong.
And so with all of these newer types of glucagon, you can administer almost with a fail-safe. My daughter has a peanut allergy and so she carries an EpiPen with her all the time. And I learned a very long time ago how to administer an EpiPen, and I think these days, peanut allergies are so common. If you don’t have a peanut allergy, you know 10 other people who do.
The way of administering an EpiPen is very universal nowadays. So the fact that glucagon is becoming more of that type of a way to administer things, it’s wonderful. It takes the fear out, it takes the scary part out.
I know that if somebody is low, perhaps on the ground, and has a form of glucagon with them, that I can help them, and that’s wonderful.
Lala: I love that. To close out our discussion on glucagon, I want us each to share our words of encouragement for people to go ahead and ask their doctor or their healthcare provider for glucagon and to fill that prescription. Ginger, I’m going to start with you.
Ginger: So easy. Just carry it around in your pocket in case you need it. There’s no reason not to have it. It’s like putting on a seatbelt when you go for a drive, you hope that nothing happens, it causes you to fly through the windshield, but it’s just in case. Let’s put a seatbelt on. Just ask your doctor for the prescription. So easy.
Eugenia: We are lucky to have all that options now and those options are made for people that don’t have diabetes. Everybody can use it, even somebody that isn’t used to injections—they can use it. It’s easy. Even the kids, if you train them for a situation, your kid can save your life and that’s really important.
Todd: For a lot of us, if you’re lucky you might not even need to go to your doctor. I messaged my doctor, he was able to just fill the prescription remotely. I hope I never use it, but I feel a lot safer having it. I’m less likely to panic into a rebound high. Just knowing that worst comes to worst, I do have glucagon with me. And it’s small, it’s easy to travel with, there’s no reason not to have it, assuming that it’s accessible to you.
Lala: I really want to encourage people to also think about the people who love you, who want to be able to help you. I know in the past couple of years when I’ve had a really severe low, it’s scary to watch.
If someone loves me and they see me going through that, they want to know that there’s a way that they can help if things get bad. It ends up not just being about you saving your own life, which is of course very important, but it’s truly a way to give a gift to the people who love you, to give them a way to help you. So we really encourage you to go ahead and get that glucagon prescription filled.
Educational content about new glucagon options is made possible with support from Zealand, makers of Zegalogue glucagon, an active partner of Beyond Type 1 at the time of publication.