Treating extreme lows

hi all, i have just recently purchased my first glycogen hypo needle thing. i was just wondering if there were other ways of treating a low if you are unconscious, like maybe there is some sort of paste that can dissolve in the saliva or something, it would be really cool to know of any suggestions because having to buy a new glycogen needle seems like a waste, and they're pretty expensive, not that I'm planning on having a severe low anytime soon. Thanks Adele

Hello Adele:

Glucagon makes those around us feel more secure but Glucagon always is the "last ditch" effort.

Its NOT one step (not like an epipen), and does require mixing things, withdrawing and then mixing.... because it has a SHARP, LONG needle.... for most the Glucagon kit is entirely too scary and will never get used because of such challenges. The fact it has to be replaced every year... extremely questionable stuff, IMV.

The after effects of an injection.... no way in hades I'll permit one to be used on me. Prefer the ER thanks... hopefully the new kits that are being developed will fix these ridiculous problems.

What you are talking about is preferring, using any of the gel products. Tubes of basic Cake Icing work easily and are very available. The only challenge you have to make sure some of the generic icing tubes require cutting off the tip before being able to use them.

As such, often we're better using the brand name icing tubes which have the twist off tips, and very easily used instead of having to search for something sharp to get it opened.

Even semi conscious any of the gel products get absorbed once its squeezed in our mouths. They are easily gotten, fairly cheap, and will buy someone time to be able to make decisions/judgements. Because there is nothing sharp, pointy, nobody will ever balk to use them...

As Stuart said you can use the gels or icing which may be a bit cheaper or honey, I read that honey is recommended for cats who are diabetic who become unconscious due to hypoglycemia. You rub it on their gums and it raises their bg buying you some time to get them to emergency treatment if needed. If it were me I would still get the glycogen because that could be life saving, hopefully you will never need it. It does make you very nauseous but you can get a med to treat that.

It can also be injected in smaller amounts in smaller syringe if you're having a non responding low and you can't eat anymore. The needle is big- I had to inject myself with a similar needle for lovenox injections for a few days when my inr went too low on warfarin. I was ok doing it although the first time I had someone else do it because I just couldn't get myself to do it. That was into fat not muscle and I was able to angle the needle so it was easier maybe.

I can't wait until "mini-glucs" become common with a pre-mixed stable formulation. Mini doses usually avoid any nausea and you also escape eating useless calorie glucose tabs.

Me too Terry. I didn't even think of that, it would be nice not to have to eat when you don't really feel like it in the middle of an awful low or even a mild one for sure!

It will be interesting when the mini-dose pens come out. I would prefer to take an injection when low (just like when high) to eating, especially for anything more than a minor low. I understand that they are also developing an auto-injector which will be one or two steps, similar to an epipen, which I can't wait for. Only problem I'd have is making it clear to people which pen to use for severe lows and which to use for an allergic reactions.

A note to the OP that I was always taught not to put anything in the mouth of someone who is unconscious, and I would think this would apply to people with diabetes. Semi-conscious is probably fine since you can still swallow, but someone who is completely unconscious could choke on icing or the like (although rubbing it on their gums might be safe, if someone wants to stick their fingers in your mouth...). This is when the glucagon kits are used, not when someone is still able to eat/drink and thus use icing or juice.

I'm looking forward to it... although I can feel very hungry with my lows I often don't and I may also feel nauseous etc. At first it seemed like a treat most of the time to be able to eat some candy, but I don't enjoy it much when I'm having a bad low. I wonder how the glucagon is speed-wise compared to glucose drinks etc?

Good point about not putting the gels etc. or icing anyway, (the gels may be designed to melt or something like that), in someone's mouth when they're not conscious.

Maybe you can label the glucagon in some way to let people know that is for hypos/diabetes?

Yep, I think I'll probably end up labelling each of them.

I've had the gels and I don't think they melt. But even if they did, I'd think the liquid could still go down into someone's lungs if they weren't able to swallow it properly...

The Xeris G-Pen, the larger emergency dose, is in stage 3 trials. It's little brother, G-Pen Mini, intended for daily use, is in stage 2 trials. I hope it all moves in 2015.

If you're unconscious from a low, glycogen administered by a loved one can save your life, reduce brain damage, etc. I have a hard time getting my head around your concerns about waste and expense under that circumstance. How often do you become unconscious from lows? Yes, rubbing sugar on the gums will lead to some absorption and eventually a modest systemic rise in BG, but if you're lying there unconscious and heading into a coma or death, it's likely to be too little, too late. So I'm having a hard time taking this question seriously. Sorry if that's too blunt, but am I missing something?

Hopefully it'll come to Canada soon after it's approved in the States!

I tried a gel in a package recently( I think it was thinner than a tube gel) and it almost seemed to evaporate- but I agree... @Adele tell people not to give you anything orally if you're not conscious and just pay for the glucagon. It's worth it if you ever need it. I think some doctors/diabetes centers may give glucagon training sessions if your /friends/family can't handle injecting you.

It could be a different brand. The gels I've used are nasty. I'd advise people use icing over gels. As a kid, even barely conscious, I used to spit out the gels my mom would try and squeeze in my mouth during serious lows. Ugh. I think I'd have liked icing sugar better.

A glucagon kit is the type of thing that you carry but hope you will never have to use. Just like people who carry epi-pens hoping they will never need them. It's similar to buying insurance, in a way. Sure, not a good plan if you end up never needing it, but worth every penny in the event that you do, since it will save your life. And, unfortunately, with things like lows, it's impossible to predict when a severe low might occur.

The problem is that when you're unconscious, it's dangerous to put anything your mouth because you can't swallow. You're right, they're expensive! But keep in mind that most people are pretty lucid and functioning even when they're in the 40's. It's once you get down into the 30's or lower that you could potentially drift into unconsciousness. I've been fortunate to have good hypoawareness even after 31 years of it, so I've never had to use one. They have all eventually ended up in the garbage after not using them from year to year, but I know I need to keep one on hand. The more you can train yourself to be aware of lows coming on, the better. If you don't get the usual sweating/shaking signals from your body, try to make a log of how you feel (or record yourself describing it if you can't write at the moment) next time you go low. Do you feel confused? A little incoherent? Are you seeing spots? Earache or other oddball symptoms? This can help you identify it soon enough to pound some candy or glucose tabs. Also, I've recently found that if you swish the chewed up candy or juice in your mouth for 2-3 minutes before swallowing, that gives it a head start because it absorbs through the membranes and under the tongue.

I agree with niccolo and I have had T1 diabetes for 50 years. You use Glucogon when you are unconscious and there is danger of brain damage or even death. No glucose in the brain is the same a sno oxygen to the brain. Glucogon is for emergency situations when someone finds you unconscious or unresponsive to oral therapy.

I believe that most people who recommend gel icing are referring to rubbing it on the gums. This reduces the risk of choking and at the same time gets absorbed through the mucous membranes so it's absorbed fairly quickly. This can be done just by squirting the gel onto the gums and then rubbing it in through the outside of the mouth over the skin. It's pretty much as effective as glucagon without the side effects or expense. I agree with finding icing gel tubes that don't need the tip cut off, but pretty much anyone can be taught to administer cake gel that way whereas most people are extremely put off by the steps and the needle size of the glucagon currently available.

FWIW, I have been as low as 17mg/dl (1 mmol) and recovered with glucose tabs. The only time I "passed out" was when I was @ 23 mg/dl (1.28 mmol), tripped on the legs of the stool in my kitchen, and greeted the tile floor with my head.

I had a glucagon injection after an insulin stimulation test. I wasn’t unconscious, just low (40 so not even that low) but that was just the protocol and how that particular doctor did the test. It’s not that bad so no one should worry if you ever need to have one. It brought me up quick, of course, to 220 and yes it did make me sick to my stomach but only very briefly. Mixing it isn’t that big of a deal either, the directions are clearly printed on the box.

Odd to correct a 40 low up to 220 with glucagon when a few glucose tabs would have served the purpose much better.

Yes, the blood serum reading was a little lower than the meter, but still could have been corrected with sugar. He was looking at other hormones levels with the insulin and perhaps with the glucagon injection too, cortisol, growth hormone…etc. They wanted to do the injection after an OGTT too when reactive hypoglycemia set in, I refused and raised it with carbs.