Did you get the point of why I did that? I wanted to see how an AP pump algorithm would work for me. I’d rather do it when I am aware it is happening, instead of waiting for it to happen without me knowing, and discovering that the pump stopping my basal didn’t fix anything.
What I learned is very important to me. Cutting basal isn’t a good way to fix my lows. That is very valuable information for me.
Being at 50 for a couple hours is not big deal to a diabetic who got the disease almost 40 years before CGM was invented. Do you think that never happened before? It’s not like the first 200 times it happened on its own it was fine, but dang it, when I did it the 201st time, I really screwed myself up. And it’s not like I do this as a daily habit.
I understand your concern, but the context of the conversation was clear. That type of thing was not recommended.
The only way we ever know how something works for us is to try it. This forum is full of posts about people trying a new insulin and talking about it.
I wanted to know how the algorithm would work for me, and was amazed to see how it does nothing! Being new to a pump, I really felt it was important to see that. I’ve never been able to cut basal before, since I was on Lantus and NPH.
I can also go low for hours with no response at all from my body, even at sub-50. I agree with you that I would rather some response. Even if it resulted in highs, it would be a safety net when sleeping alone. And I have plenty of other stubborn highs that don’t come down even though I know for sure they’re not from rebounds.
My endocrinologist says that most long-term Type 1s don’t produce much glucagon when low, especially for people diagnosed during or prior to adolescence. Were you diagnosed at a young age like me, @Eric2?
Based on a quick Google search, it does appear based on studies done with CGMs that the “Somogyi effect” (rebounds after overnight lows) is very rare.
I use a method a lot like @Eric2. I take Lantus twice a day, and since I would find myself forgetting if I had dosed, I started using the same pen needle for the two doses. That way, if the pen was sitting there in the morning with no needle on the tip, I know that I haven’t injected yet. Then after my evening does I remove the needle…so if my pen has a needle on it at night, then I know I haven’t injected yet.
Yes, I was 5 years old. I have never had this, which is why I find it so fascinating!
I always thought the alpha cells of type 1’s went dormant (not dead, just dormant), which is why we didn’t rebound on our own. But that a glucagon injection worked, simply by doing what the alpha cells were supposed to do.
Terry, were you diagnosed later in life? That would support Jen’s google look-ups.
Jen, does cutting basal fix your lows? Or is it like me, where you will just stay low for hours, even after your basal has stopped?
That whole scenario is frustrating to me, because the big news about how pumps will automatically cut basal and help diabetics, and my body is like…“So what? I’ll stay low if I want to…” So all that wonderful technology will have minimal effect for me.
Yes, I was diagnosed when I was 30. I thought this was a type I thing but perhaps is more selective than that. I know I’ve read about this many times on this site from T1Ds. I am surprised to read now that it is rare. I have witnessed it many times. I’ve used a CGM since 2009 and have seen this over and over. The explanations I’ve just read with a quick search also say that not only glucagon can elicit this effect but also growth hormone and cortisol can play a role.
I’m using an artificial pancreas system now and cutting or stopping my basal rates will avert a hypo in me. I have evidence of this every day when I wake up and look back at my BG and basal profile during the night.
More validation for the oft-repeated theme here, that YDMV, and also the foolishness when doctors make recommendations for “everybody”.
I have taken glucagon shots when awake that did nothing for me. But when I am asleep, it shoots me to the moon. Have you ever taken a glucagon shot? How did that affect you?
I have been using MDI technique for 4 years. I will be getting CGM & Pump soon. So without CGM cant know for sure. But in past, I checked during night few times. I wasn’t low. My target range is 80-140 mg/dl. Lows are always immediate concern. Its better to have highs rather than lows. It may be possible that I have counter-regulation due to night lows. I will often test in similar situations.
I’ve never received a full-dose emergency glucagon shot but I have taken mini-glucagon doses to counteract hypos – about 10-15 units measured in an insulin syringe. They worked to turn around a trending hypo and added 10-20 mg/dL to my BG. It was nice not having to ingest calories to treat a low. Shelf-stable glucagon will be a big leap forward in diabetes treatment.
I can’t wait for this. I’ve also never had a full glucagon shot, and I’ve never done mini glucagon, but that’s mostly because it wastes the whole kit (there are times it would have been very helpful). Once I can start carrying a glucagon pen and just take a few units when I"m low, that will be so exciting (especially at night!) and may help me lose weight as well.
If you’re alert, coherent, and capable enough to mix up glucagon and then calculate and measure out a miniature dose of it, why not just eat some glucose tablets or juice or whatever instead?
I was taught they’re for emergency use only… e.g. Unconscious or seizing and can’t swallow… even the paramedics I know won’t administer it unless it’s a life and death situation and there is no other option
Mini-dose glucagon has, in the past, mostly for situations where someone can’t eat because they’re vomitting, upset stomach, or something similar, yet they are not yet in an emergency low situation but are still unable to get a low blood sugar to come up. Using mini-dose glucagon mixes up the glucagon solution but then draws only a few units into a syringe, so it’s nowhere near the full dose.
Mini-dose glucagon has been successful enough that they are working on developing a glucagon pen that can be used to treat mild to moderate lows.
Considering that people without diabetes have bodies that will raise a low blood sugar with glucagon, not carbs, I’m very excited about this treatment option.
Glucagon is a last resort. It is really not for self-administration, it is when someone else has to assist you and there is no way to treat a hypo effectively with carbs. The serious thing about glucagon is that is “extreme” and essentially causes the liver to dump all of it’s stored glycogen as glucose. Perhaps 150 to 175 grams. And most people feel terrible afterwards.
While that averts a serious hypo it also takes like 2 days to replenish those glycogen stores. If in that time you have another serious hypo you have no last resort. Glucagon won’t work. That can be very, very bad news.
I color outside the lines sometimes. Mini-glucagon shots serve a valid safety purpose. Here’s one story of a mom dealing with illness in a T1D child. Google “mini-dose glucagon” and you’ll see discussion and recommendations from reputable sources to use mini-glucs.
My use of mini-glucagon doses was a personal self-experiment to see what effect, if any, they had on me. I found a protocol published by a hospital in Canada and used it. I used them for moderate trending hypoglycemia, in 55-70 mg/dL range. I was monitoring my BGs with a CGM and fingersticks.
I learned that if I was throwing-up sick but had already taken insulin that I could counteract the insulin with small doses of glucagon. The relative dose size I used was probably less than 5% of the emergency dose size. I find that knowledge valuable.
Knowing this also brings me real hope that the development of shelf-stable glucagon will be a large step forward in diabetes treatment and is likely to be available in my lifetime. The glucagon kits go out-of-date in a year or so. My use did not waste them.
My first knowledge of this tactic came from former diabetes camp attendees. The staff routinely did an overnight BG check and camp management found the mini-glucs effective and safe. I suspect that this off-label use of emergency glucagon was thoroughly discussed with the camp’s medical staff. Mini-glucagon doses to counteract too much insulin is apparently not a new tactic.
As Jen and Terry already mentioned, there are various reasons why you would do this yourself - feeling sick and unable to eat, not able to get food fast enough, realizing you had made an insulin dosing error, still having normal BG but in a state of dropping rapidly, having no access to food. All valid reasons to do a mini-glucagon dose.
I agree with Terry and Jen, shelf-stable glucagon will be a big leap forward in diabetes treatment.
Some day (hopefully soon) it will be easier to use. They were at one point, actually trying to integrate it into an insulin pump. Rather than passively treating a low by cutting insulin, it would pro-actively treat a low. This would be tremendous for people.
The problem they have with glucagon in a pump is the lack of stability. Once it is mixed. it doesn’t last. But the idea of doing mini-glucagon doses was already in sight of pump companies and Endos.
In my view, if they are working on integrating mini-glucagon dosing into a pump, it isn’t really something to be afraid of. If it is done in the right quantity, it can be a great tool.
Well I could have been more accurate in my description of how I did the dosing and the circumstances surrounding it. But my comment was made in context of the comparison I had with Terry, in terms of how he rises from a low, and I do not. So I was wondering how glucagon affected him.
When I did it, I ended up not getting any rise in my BG from the first small dose I gave. So I gave a little more. And then a little more. I ended up taking 1/2 the total dose you would for being unconscious, and it didn’t budge my BG one bit.
It never did anything for me.
But that is valuable to know. I think it is LESS dangerous for me to know it’s lack of effect, and to not rely on a mini-glucagon dose in an emergency, than for me to not know and one day find out the hard way.
So I think of something like this as checking the fire-extinguisher before a fire. NOT playing with the fire-extinguisher for fun…
A recommendation to prevent accidental double dosing of basal insulin (tresiba or otherwise)—Timesulin pen caps. They are so helpful! They have an automatic digital countdown timer built into the cap (which you replace your pen cap with) that resets every time you use the pen. So useful given that it’s super hard to remember whether you did something you do every day. I found them for cheap ($7, compared to the retail price of $30) on Amazon prime for all the different pen types (the one for Tresiba linked below). Also, each one seems to last a long time—I used my Lantus one for the better part of a year without needing a replacement before switching to Tresiba now.
@Eric2, you may be right about the cause. We didn’t talk about that. I have also read that the alpha cells are dysfunctional, not destroyed. But apparently there are studies showing that, especially in kids and adolescents, there is little to no counterregulatory response to lows.
I do find that cutting basal can help prevent a low, but only if I catch it very early (before I’m low), and usually I also have to eat something.
Last night was a perfect example of how I can go low and not come up until I treat. I went low shortly after midnight and finally woke up and ate glucose tablets at 4:00 AM. (Note: this is very dangerous. I do NOT recommend sleeping through a low for many hours!) There is a little blip that may have been an attempt to correct from my body, but also could have just been sensor variation.
The low that happened in the morning (with significant IOB—an example of how both basal and bolus settings vary for me) I treated with a combination of glucose tablets and cutting my pumps basal to 0% (so really 50%, since I’m using Lantus) for two hours.
So all that wonderful technology will have minimal effect for me.
