How Much Should BG Rise From Glucagon?

Type 1 and LADA
#1

Worst low of my life last night. Took my Lantus injection (29 units) at 6p.m. as I normally do. 30 minutes later I noticed on my Dex that I was dropping and then felt really faint so I sat down and asked hubby for glass of milk. Fingerstick at 87 while he was getting milk. Within 15 minutes I went from 87 to 28, fuzzy and could not think. Hubby grabbed glucagon and gave me injection. I'm really proud of him because he's never had to do this before. This is only the second glucagon shot I've had in almost 25 years and the first was in a hospital. I'm just so thankful that he was home at the time.

I always thought that glucagon raised your bg level fast like within 15 minutes and that it raised it significantly. Is that not supposed to be the case? It took 3 hours for a glucagon shot and 150 g of liquids to bring me above 130 (I kept drifting back down slowly and wanted to be above 120 to sleep). Of course, I ended up at 350 by 11p.m. so I corrected then went to bed and woke up at 240 this morning.

My poor hubby was really shaken up with this one because he said he felt so helpless and I wasn't sure if I could take a 2nd glucagon shot if I had crashed again. Hubby called the endo on call who said to do whatever I needed to do to get it up if it happened again including a 2nd glucagon shot. On call doc also said that sometimes it will come up fast and other times it will take 1 hour or even 2 hours. Well mine took 3 hours, lucky me. What has been your experience with glucagon?

I just wish I knew why this happened. How can you fix it if you don't know why. I had no active insulin on board, last bolus was almost 5 hours prior and it was only a 0.5 Humalog correction. The endo on call mentioned adrenal, kidney and liver function but I get the routine tests although I've never heard my endo talk about adrenal function. Waiting for my endo to call so I can ask. Have any of you dealt with adrenal issues?

The endo on call also asked about injection site and that is a possibility because I've been using a different site to inject in my abdomen for the last few weeks due to scar tissue but wouldn't this have happened sooner? And I thought Lantus was not short acting?

Now I'm afraid to take my Lantus injection tonight since it happened 30 minutes after the Lantus dose. I'll cut the dose back after talking to my endo. On call doc said 10% but my instinct is to cut it back more than that at least for tonight. As it is, I'm aiming for a higher target today since I still have that Lantus dose in my system in case that's the problem.

I've been doing so well the last few weeks staying almost always between 80-140. And then this...

It's just so frustrating not be able to look at data and find the problem. I'm comfortable with data and fixing problems. These gremlins and unknowns and what ifs and maybes drive me insane.

Thanks for letting me rant. Please let me know if you have any other thoughts on what might have happened or similar experiences you'd like to share.

#2

Wow...yeah, that sounds scary. The only thing that comes to mind is that perhaps you hit a blood vessel? I don't know if Lantus would act so quickly if it accidentally ended up in the blood stream (I know when I've done that with humalog or regular I've dropped like a rock). My experience with glucagon is more in line with what is probably typical (about 1-2 hours).

How long ago were you diagnosed?

#3

I was diagnosed almost 25 years ago. I've had lows before but this dropping so fast and hard is new to me...and I don't like it! :) I wondered too about hitting a blood vessel but I didn't see any blood when I injected although I guess I might have not noticed. I'm going on OmniPod soon so I can't wait to get rid of the Lantus. Of course, I don't really know that's what caused it but for it to happen 30 minutes after...

#4

Yikes, that had to be mighty scary! Glad you came through ok and that your husband was there.

It's just so frustrating not be able to look at data and find the problem. I'm comfortable with data and fixing problems. These gremlins and unknowns and what ifs and maybes drive me insane. Yup, me too! The issue, as I see it, is that there are more variables that have an impact on our D that we don't know, than ones we do know and therefore can manage. It's incredibly frustrating to put in so much work and have those *$&%^ gremlins come and do their thing!

#5

Really scary, glad you made it through!

To answer your question about glucagon as best I can, since it is an insulin antagonist, much of glucagon's action depends on insulin.

Honestly, my first thought after your description of your episode is, and certainly not to suggest that you are not diligent about your diabetes managment, is that, perhaps, you mixed up your Lantus with your short acting? That wouldn't be the first time in the history of basal/bolus diabetes care that something like that has happened.

That would explain your sharp BG drop within minutes of taking your dose, and the fact that glucagon took so long to kick in. 29 units is a lot of insulin to counteract.

Just a thought.

Also, agreed about the Omnipod, or any pump for that matter. Lot's more variables to deal with mechanically, but going over to just one type of insulin, more importantly, getting away from Lantus, made life much easier.

#6

Thanks FHS, I had that thought too and I've had moments before where I was like wait did I take the right one.. But I'm sure I took the right one last night because my Lantus vial was nearing the end of the vial so when i took the injection I set the vial down to discard it so it was still in eyesight. The other weird thing is that usually when I get to the end of a vial it seems a little less effective, which kind of scared me too because if this was from an older vial what would a newer vial have done?

#7

Wow, just one of those things. =/

I bet you'll'll find every sock you every lost in a dryer before you find an answer to this one. =/

On a brighter note, you're gonna love the pod!

#8

wow, this is VERY scary..and my worst fear. Lantus can't possibly just drop you like that...so, something must have happened. I hope you find out what it is or was? Thank godness someone was there for you!

#9

Yes, I'm excited about the pod! No more Lantus and can dose in smaller increments! :)

#10

FHS: i'm getting ready to go on the pump...are hypos less frequent with pumps. geez, i read this post and it scares me to death. I too am having such a difficult time with my basal insulin too, levemir (lantus too when on it). If I get a low with my bolus, I can fix it right away, my basal drops me in the middle of the night, no matter what I do, or it keeps me a bit too high. this really, really scares me.

#11

I'm sorry to hear about your experience. One thing about Lantus, you are cautioned to make sure to inject into your bodyfat. This is described in the information that comes with Lantus, but they don't really explain why and the risk. The way that Lantus works, if you accidently inject into muscle or the blood stream, it can act as rapid. That sounds like what happened.

Now, here is the problem. Your liver normally stores about 100-150g of glycogen (essentially glucose). When you use your glucagon pen it signals your liver to dump all that into your blood stream. So that is how it works, but there are limitations. First, that is only a limited amount of glucose. And then, once you have dumped it, it is gone, you don't get a second shot until you have replenished the stores, which could take days.

So if your ICR was say 15:1 and you injected essentially a rapid insulin, you would need 15*29 = 435 grams of carbs to offset that injection. Your glucagon shot released an amount of glucose that was probably far short of what you needed.

I think your experience, while scary and serious can hopefully serve as a learning experience for all of us. If you use Lantus there is a risk of a misinjection and it can act as rapid. Also if you mistake you bolus for basal and accidently inject rapid, you can end up with the same thing. And while glucagon can help you, it can only release a limited amount of glucose which may not be enough.

Please kiss your husband, he did the right thing and may have saved your life.

#12

I don't think trhere's a definitive answer for your question either Type1Gal. =/

It's going to take a period of adjusting your basal, as well as every other variable you have to consider, in order to keep your BG's steady and in a normal range. Anything can happen if your basal and bolus adjusments are not correct, including lows at inopportune times. =/

I, personally, have fewer and less frustrating lows than when I was on Lantus because a pump is just subject to much finer control. I still have them, but nothing dramatic, so far.

#13

Thanks bsc, this helps alot. After all these years on Lantus I did not realize the ability to act as rapid...maybe they don't tell you that because nobody would want to use it... :) It's also good to understand the limitations of the glucagon injection.

My poor husband was really shaken with this as was I. I knew I was in trouble because of the way I felt. If he had come home an hour later.... and I've only been keeping glucagon kits around for the last few months. I have one left right now but am getting extras today at the pharmacy.

#14

ok, thanks. this just makes me NOT want to do this anymore, any of it. this is crazy..! manually controlling our blood sugars..I mean, c'mon. now I'm scared all over again. I'm going to talk to my endo about this..ask his thoughts on what 'may' have happened because this scares the crap out of me. ugh!

#15

Well, unfortunately it can. Gretchen Becker wrote a nice article on this over at healthcentral.

#16

I know, Type1Gal, it scares me too but this is the first time this has happened to me in almost 25 years of using Lantus/Humalog. I was on a 70-30 mix when I was first diagnosed and that was worse because you have to eat when the insulin peaks or you'll go low....I would regularly get caught at meetings at work and be shoving peppermints in my mouth and sweating until I could get to food. I'll be glad to get off the Lantus too though.

I keep myself sane by telling myself that things like this happen but I could also get killed in a car accident on the way home.

#17

Wow. Thanks for this article bsc. They should really give this article to anyone taking Lantus not to scare them but to be prepared and aware. That does sound exactly like what happened to me.

#18

Hi bsc. Must Levemir also be injected in only bodyfat to avoid this rapid use? I'm glad now that I take my Levemir in three shots daily, meaning smaller doses in case of a problem.

#19

well, maybe that's another reason to split our basal doses up...I take very small amounts (split doses)..so, that helps and also am very careful where I inject. The changes of this happening are 'RARE' as they said....maybe it was the bolus and not basal you took last night????

#20

me too, trudy...i just posted that...!