Using Glucagon when you are awake -but can't get your sugar up?

I had a scary low last week when I was sitting at 50 for over 45 minutes (alone in my car waiting to come up so I could drive home from work). 15-20 glucose tablets and I was still 50. Finally after like 45 minutes, I finally came up to 70. I spoke to the NP who takes care of my D, and she recommended the next time this happens to contemplate using the Glucagon. Anyone ever had this happen? I didn’t even think to use the Glucagon because I was awake.

Yes, some people have used it. Remember that you may be nauseated afterwards and do wait to get over it before driving.
At 50, you do not normally need the full dose.
However, it sounds like you went down a LOT further than 50 since that glucose amount, 80 grams, was required to pull you up. So it’s hard to say about the dose. Maybe someone will come on here and venture a guess.
How high did you go with the 80 grams finally, and after what length of time, and what amount of insulin had you injected in the prior 3 hours? Just for my own knowledge…
How many grams of carbs does it usually take to move you up 10 points? Could your tester have been too warm or too cold (its battery, that is)?
I’m always this full of questions. Don’t mind me. That IS scary, and doubly so when by yourself.
Do you happen to be lowering your carb intake or exercising more - and your basal higher than it needs to be right now? Maybe your I:C ratio is changing? Do consider all these things that might have preceded it.

I’ve had lows that were hard to raise & it usually doesn’t take much for me to start inching up. All I could figure out that I was still dropping so the glucose wasn’t having an effect. Maybe my pancreas decided to send out some of my own insulin that night. I stayed at 45 for almost two hours. I hadn’t taken much insulin either. I drank juice because that works fasters. Glucose gel works fast also, but tastes awful.

15-20 glucose tabs is a lot. One gram glucose raises me 10 pts. Where you ok later without going high?

I don’t carry Glucagon with me, though I probably should. Glucagon can make you vomit, as Leo said.

I forgot to mention - I also use Byetta in addition to Apidra for meal coverage. I am sure the action of the Byetta (slowing gastric emptyimg) had something to do with the lack of glucose tab absorption. I didn’t have any juice in the car, and I am not sure that would have made a difference. After a couple of hours, I peaked out at 128, so I am pretty sure the Byetta had something to do with it. I was past my peaking of Apidra that I had with my dinner, but the Byetta would have still been active. I never thought to use the Glucagon while awake.

That makes perfect sense. It must have been the delayed stomach emptying. Great that you only went to 128.

I never really thought of using Glucagon either. I think of it as something for when we’re super low & unconsious.

Glucagon should probably be considered a treatment of last resort. Glucagon causes a severe counterregulatory response and has some pretty distasteful side effects, and most important, if you use glucagon, you will be unable to use glucagon again for up to several days, leaving you vulnerable. Have another hypo and need it and you won’t respond. Bottom line, probably not a treatment unless you appear to be imminently headed towards unconciousness, seizures, or your blood sugar levels are at a level that would cause damage, none of which is true at 50.

It is true that Byetta causes delays in digestion and a better course of action might have actually been to chew the glucose in your mouth and hold it. You actually absorb glucose in your mouth. I would actually have been surprised tho if you at 15-20 glucose tabs at 15g carbs each, had delayed absorption and did not experience a high later. Something else was probably going on.

4 gm carbs each tab for the ones I use. I think the Byetta flattened out the spike that may have occured later.

I though about giving Glucagon to Manuel once, after a party where he had some drinks… because his sugars when down very fast and will not come up 15 minutes after drinking juice, but instead he will go down. Still awake but not really responding too much, he went from 45 to 34, two arrows down on the Dexcom.

I went for the glucagon inyection… but since I am so afraid of using it, and was not sure about the effects of alchool in the blood and glucagon, I went online and stared reading… the information I found confused me even more, so I disconnected his pump for few minutes… gave him more carbs, although he didn’t wanted the carbs or to disconect his pump… and very slowly he starting coming up to 77… the next morning he woke up very high.

It was a dreadful night, I was about to call 911. Lesson learned I hope.

I agree. Talk with your endo about what Byetta may have done. He may feel it’s counterproductive for you.

I am not a friend of juice. The amount of carbs can be different from company to company, from lot to lot, from top to bottom of the bottle (if not mixed right). As I wrote in Danny’s discussion I want to get out of the low as quick as possible with glucose tabs.

But in Jennifer’s case she took many glucose tabs and still the low continued. Being alone I think the glucagon is an option to consider in this situation. But normally I take no glucagon with me because the freak lows as I call them occur very rarely (I had 5 freak lows in 20 years).

I have been home alone and was still concious at 33 and used the gluagon shot to pull me back up the only problem was when I checked it a few hours later I was VERY high! Once a paramedic told me that the gluagon shot had a very bad side affect and I ask him what he contuned to say that it would cause really high BS.

My husband is scared to give me Glucagon also. Guess he would if it came down to the wire, but he’d probably call 911 first. Glucagon can have yucky after effects. Glad I’ve not needed it so far, knock on wood!

Glad you raised the question about Glucagon & alcohol. Hmmm, never thought about that. The worst lows I’ve had have been from drinking. No more than two drinks for me or I crash.

slightly off topic … but i never heard of glucagon until a month or so ago when i saw an online reference. i’ve been T1 for 50 years and none of my endos has ever mentioned it or suggested i get it. interesting. i’ve never needed it; never had a sticky situation in all those years - never gone to the hospital for a D-related event, never had a seizure or been incapacitated by a high or a low. so i’m wondering how critical glucagon really is. this isn’t meant to be a combative question, i’m just interested in people’s views on the question.

To me it’s been a life saver! I’ve had some really low lows. I first heard of it not from my doctor but from a paramedic who came every month to bring up my bs and take me to the hospital only to get out about 6 hours later. I then went to my Dr and ask for a prescribition.

I’ve never needed it before either, but I do regard it as essential for safety. The reason is because if for whatever reason a diabetic person were to pass out, they can no longer safely ingest carbs. If someone is unconscious, they can’t eat or drink. If this is the case, a glucagon injection is the only thing that anyone can really do to raise their BG (at least without being in a hospital environment). For this reason, I really do feel like it’s necessary to have around; even if we do go years without needing an injection.

Last summer I spent all day concert where I was on strong antibiotics and out in the sun. I ended up vomiting all night, to the point where I couldn’t even eat a glucose tab or drink juice without it…coming back up! I was of course dropping low so decided I didn’t have much of a choice but to try glucagon. It’s the only time I’ve taken it, and it worked like a charm, but I can’t say whether it caused nausea since I was already in the thick of it =)

I’ve never heard about it being ineffective for a few days after you use it…so I guess it really needs to be a last resort!

It is critical if you have a low and are uncosncious and are away from prompt medical help. As you know, hypos can cause seizures from lack of glucpse to the brain (which can lead to death possibly). If you are unawake, or unable to consume glucose tabs or other hypo remedies, it can save your life if your family or friends can give it to you while awaiting medical aid. Your family should never give you anything orally if you are unconsciuos or unable to protect your airway. Glucagon is helpful and potentially lifesaving in these situations.

I have never used glucagon but have heard of it being used with regular insulin syringes in “mini doses” at times when either food can’t be eaten (due to vimitting, unavailability, etc.) or when blood sugars aren’t coming up on their own. Here’s some information about it:

I’ve read that when used this way it doesn’t have side effects (like vomitting, high BG later) to nearly the degree that using the full dose of glucagon at once does.

This is an interesting use of glucagon. I am not aware of glucagon being part of any recommended insulin treatment regime for blood sugar control, but if you follow the literature on work for the full closed loop pancreas, you will see that it is being looked at as part of those systems. Small doses of glucagon are used to increase the rate of glucose produced by the liver, thereby enabling these systems to exert controls to both lower and raise blood sugar leading to much faster and stable control. Used for manual control the resulting blood sugar increase causes by the glucagon can be very unpredictable since the presence of insulin suppresses the response by the liver.

It’s my understanding that high levels of insulin suppress the release of glucagon itself, which then stimulates the liver to break down glycogen into sugar. Once glucagon is in the system, though, I don’t think high levels of insulin interfere with it (though alcohol or recent heavy exercise would), but maybe I am wrong.

In people without diabetes the body releases glucagon whenever it’s needed. The problem is that for those of us with type 1 the release of glucagon in response to lows is highly blunted regardless of the amount of insulin present, and/or when glucagon is finally released it is too much, causing a rebound high. In the site above, the mini-dose glucagon would be used in order to avoid a trip to the hospital for treatment to prevent a severe low.