Beyond Type 1 Staff Story: I Should’ve Used Glucagon

Like many people with diabetes, I was taught that glucagon is only used if someone passes out from low blood sugar. Since I haven’t passed out from low blood sugar (knock on wood), I didn’t think much about glucagon.

Glucagon isn’t just for when you pass out

I now understand that glucagon can be used in any case of really low blood sugar, known as severe hypoglycemia. Severe hypoglycemia means the low blood sugar is so bad that a person can’t do things normally or think clearly. 

Many people believe you should wait until someone is unconscious before giving emergency glucagon, but that’s not true. It can be used earlier. And in most cases, it probably should.

If you have a really low blood sugar, giving yourself or someone else glucagon is one of the safest things to do. The hormone makes the body release sugar from the liver and muscles, which helps raise blood sugar to a safer level.

I should’ve used glucagon a few times

Over the past few years, I’ve had several serious low blood sugar episodes. During these episodes, it was difficult to chew—I usually keep raisins or gummies nearby for lows—or to put a straw into a juice box. 

Using glucagon could have helped, but I had been told it’s only for people who are unconscious. Because of this, I made decisions that could have been dangerous. I don’t want you to make the same choices, but I understand if you have.

My (lack of) history with glucagon

After being diagnosed in 1997, my family filled my original glucagon prescription, but other than a few glances at the red plastic container, I didn’t devote much thought to my glucagon, overwhelmed by the thought of such a large needle going into my thigh if things went badly.

We never trained anyone how to use it or discussed our family’s plan for when we might have to use it on me. Over the years, we refilled the prescription only a handful of times, but overall, I was content knowing there was an expired glucagon somewhere in the house and at school.

When I went to college, the glucagon went from a moving box to a drawer in my dorm room, never being mentioned to roommates or friends. When living with a boyfriend in my 20s, he knew the signs of low blood sugar to look out for that would prompt grabbing a juice box, but I never trained him how or when to use glucagon either, despite a few tough conversations about what a severe low blood sugar could lead to.

Upgrading my glucagon

Then, a new glucagon showed up. Right after nasal glucagon (Baqsimi) became available, I asked my endocrinologist to write me a prescription and I got it.

There are many new and improved emergency glucagon treatment products available today, including:

• Nasal glucagon—Baqsimi®: This is an emergency glucagon that’s administered through your nose.
• Glucagon pen—Gvoke HypoPen®: This is a premixed glucagon injection that you press against your thigh. The auto-inject device makes it quick and easy to use. It is also available in a prefilled syringe (PFS).
• Glucagon Prefilled Syringe—Gvoke Kit®: This is a premixed glucagon in a vial that comes with a syringe, allowing you to draw up the dose manually and inject it directly into your thigh.
• Glucagon pen—Zegalogue®: Also a premixed glucagon, available as an easy-to-use auto-inject device. It is also available in a prefilled syringe (PFS).

Copay cards and patient assistance programs (PAPs) can help you pay for glucagon if the cost is high at the pharmacy, whether or not you have insurance. The eligibility rules vary by program.

Learning my glucagon lesson

After I upgraded my glucagon, I told my friends how to use it and even made a short video on Instagram Stories to show them. I wanted them to know what to do if I ever passed out in front of them, which could happen if my blood sugar got too low. I told them to look in my bag for the glucagon.

Fast forward another few months—I’m taking a walk with a friend and start to realize my blood sugar is tanking. I’m a half mile from home and, in an effort to be minimalist, didn’t have anything on me other than my phone and keys. 

My blood sugar seemed fine and steady when we set out, and I thought I would be okay, but I remember my continuous glucose monitor (CGM) showing me around 100 with double down arrows. There were no stores between my apartment and where we were.

My blood sugar tanked

I knew that if I walked home quickly, I might pass out sooner, but if I walked slowly, I might not get home in time. I thought about asking my friend to run ahead with my keys to get something sweet from my house and then come back. But I was scared to be left alone and thought it would take longer for him to go and return than for me to get home.

About two blocks from home, my vision and balance started to go. My CGM showed I was around 50 with double-down arrows, but I was probably already lower because CGMs have a slight delay. Tears were streaming down my face, and I was terrified that I was about to lose consciousness right then and there.

Trying to stay calm and conscious, I talked my friend through “if/then” scenarios. Ultimately, I made it home, went straight to my cabinet, ripped open bags of gummies and poured orange juice straight from the bottle down my throat. 

I didn’t even think about my glucagon.

“LOW” CGM readings call for glucagon

It took over 45 minutes for my blood sugar to get back to normal, and most of that time, my CGM showed “LOW” instead of a number. I cried the whole time. I was really scared and shaken, and I knew I was close to passing out. I was angry at myself for not being prepared—without a plan or backup supplies.

After I stabilized, my friend and I talked about what he should do if it happens again. That’s when I remembered to mention glucagon. When he asked why I didn’t use it, I didn’t have a good answer—just, “I didn’t think of it.”

We should be thinking about (and using) glucagon

Years ago, options for glucagon were limited. Because of that, not many people think of using glucagon first when treating serious low blood sugar. But now, it’s time to change that way of thinking.

My story is not uncommon.

Just like insulin helps keep blood sugar in a healthy range, glucagon—another hormone—should do the same. With more easy-to-use glucagon products available or soon to come, we should include glucagon in our plans for when blood sugar gets too low.

Scenarios to use glucagon (that don’t include passing out)

I hate to be the one to tell you this, but if you’ve passed out from a dangerous low, it’s already too late to consider your options. That’s why it’s so important to train someone you trust on how to use it.

If you’re awake and alert, and you have a severe low or see it coming from a quick blood sugar drop, here are some good reasons to take it out of your bag and use it now:

• You cannot safely swallow: If you feel incapable of drinking or chewing your low blood sugar treatment, use glucagon—don’t play with the risk of chalky glucose tablets getting stuck in your throat. It could lead to choking.
• You need a rapid response: Glucose tablets, gels, gummies and powders are powerful ways to treat lows, but if your CGM is telling you that you’re severely low or “LOW,” using glucagon provides the quickest relief. Full stop!
  
• When you have too much insulin on board (IOB): Insulin on board reflects the amount of insulin you have in your body at any given time. Too much IOB can happen if you miscalculate the amount of carbs in a food and give too much insulin. It might also happen if you stack your insulin (take small doses back to back in a short period of time to correct a stubborn high, then experience a rebound low) or rage bolus (take too much insulin to correct a high, then experience a rebound low). 

If severe low blood sugar isn’t treated, it can lead to a coma, brain damage, seizures or even be life-threatening. Giving glucagon quickly can help prevent  these serious complications.

The thought of using glucagon can be scary, I get it. But the thought of not waking up because of a severe low is even scarier. When in doubt, give yourself the peace of mind. Don’t tell yourself you’re okay just because you haven’t passed out. 

This isn’t one of those times to “tough it out with diabetes,” though many of us have been taught that too. This is one of those times when you need to act quickly. Your health deserves it.

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