A Frightening Lack of Glucagon Access in Mexico
Hypoglycemia is a blood glucose level below 3.9 mmol/L70 mg/dL. We know that it is caused by too much insulin or too little sugar in the body.
Facing low levels of glucose (sugar) in the blood is a complicated situation itself that often generates stress. When we struggle with extremely low levels (severe hypoglycemia) we will need urgent help.
Severe hypoglycemia refers to hypoglycemia where there is cognitive disability that requires help from a third party for recovery. Left untreated, hypoglycemia can lead to seizures, loss of consciousness, and even death.
Education for severe hypoglycemia and glucagon use
When I was diagnosed with Type 1 diabetes in a public hospital — Instituto Mexicano del Seguro Social (IMSS) — I did not receive much explanation about hypoglycemia. All the information I received was “have something sweet.” I received no formal training regarding the 15g carb rule and no one mentioned I could face a life-or-death scenario with low glucose levels.
Of course no one ever mentioned glucagon.
This is an experience most of us have faced in Mexico. Despite the fact that most of my T1D peers in my country have experienced severe hypoglycemia (myself included), very few of us have had the possibility of using it, since glucagon is not accessible and does not even figure within the Table of Drugs available for the treatment of Type 1 diabetes in the public sector.
Table of medications available for T1D in Mexico
The Basic Table of Medications is the document that groups the drugs that can be prescribed in the Mexican Institute of Social Security (IMSS). In this document you can look for the codes, description, indication, route of administration, dose, generalities, adverse effects, contraindications, precautions and risk during pregnancy of different drugs divided into groups by specialty.
Medications for the management of Type 1 diabetes should appear in group 5 Endocrinology and Metabolism. However, in this basic table there is no listing for glucagon and it is perhaps for this reason that its use is not prescribed nor explained.
All the knowledge regarding the use of glucagon came to me when I was able to afford medical care in the private sector. My new doctor, in addition to speaking more in depth about diabetes management, technologies and carbohydrate counting, told me about glucagon’s use in severe hypoglycemia. Although I already had the information in my hands, there were still many other problems that until now make access to this medical resource difficult.
First, there is the difficulty to get glucagon, since it is not available in all the states of the Mexican Republic. Although a prescription is not required to buy it, you cannot find it easily since it is not an over-the-counter medicine like some others. In order to buy glucagon you’d have to request it from the pharmacy and wait a couple of weeks for them to deliver it to you.
About the cost of glucagon in Mexico
There is another extremely important and uncomfortable issue: glucagon is an expensive drug. The only presentation of glucagon available in Mexico, the Lilly pharmaceutical kit, has an approximate cost of 1,000 Mexican pesos, approximately 50 dollars.
The Mexican minimum wage is around 4,000 pesos each month, an equivalent to $200 USD per month. This is a salary in which the expenses of insulin, test strips, syringes and everything that the treatment for diabetes requires, in addition to the expenses of daily life, leaves no room for glucagon. Many would never consider the expensive medication, since they may not really be aware, due to lack of diabetes education, that experiencing severe hypoglycemia is a possibility.
If there is no economic or educational access to the use of this medical resource, what do the majority of Mexicans do?
We do what we can. We figure out ways and use faster absorbing carbohydrates, we tried to be prepared, and prepare our families to act quickly in the event of severe hypoglycemia. We are taught to seek medical urgent assistance if this happens.
An ideal scenario would be to have one or more glucagon pens in your refrigerator hoping to never use them, but that reality, for many in countries like mine, is far from achievable.
Educational content related to severe hypoglycemia is made possible with support from Lilly, and editorial control rests solely on Beyond Type 1.