Disrespecting glucagon

glucagon

Though I took the photo, I didn’t bother reading the expiration dates.

My name is Scott, and it’s been 25 years since my last glucagon shot (spoken in true AA fashion).

I have about six of these things sitting on a shelf somewhere in my bedroom. I’ll bet that at least half of them are expired. I really don’t know. They never leave that spot — even when I go on extended vacation. Every so often, my wife asks me to remind her how to use it, but we never get around to doing so.

Some people, I feel, are more liberal with glucagon use than others. If they test and see a BG below, say, 50, they take a shot. For me, I see it as a method-of-last-resort — i.e. if I’m unconscious. If I can get food or liquid in my mouth, that’s what I’ll use. As I’ve been taught (or, at least I misunderstood the training), I should never have to give myself glucagon — because if I’m capable of doing so, I don’t need it.

(Flashback to the time when I was living alone, wandered to the kitchen in the middle of the night to get some juice from the fridge, and woke up later with an open bottle of apple juice on the floor, a nice bite on my tongue, and a possible concussion from hitting my head on the counter while falling to the ground).

Perhaps I’m naive in thinking I won’t need it — in fact, I know I am — but somehow I feel that, with a pump, a CGM, and and no long-acting insulin, I won’t fall victim of a sudden insulin peak when I’m ill-prepared for it. I’m too stubborn to think it will happen to me. I still refill the prescriptions when they expire and someone reminds me, but that’s about it.

(Flashback clarification: I was using Regular and NPH at the time. Or maybe it was Humalog and NPH. Either way, it was still NPH.)

Honestly, I can’t see a need for it during the day. I can’t see a glucagon-emergency coming while I’m awake without realizing it. While asleep, despite the boneheaded excuses I divulged before that flashback, I suppose it’s possible to slip into such a low that I’m unresponsive.

This entire post is written as a response to a more serious blog post on Bigfoot Child Have Diabetes (though it’s hard to read Katy’s writing style and think “serious”).  It actually started out as a comment on there before morphing into a post of its own. Oh, and if you don’t read that blog, you should. It’s dead-serious and side-splitting funny at the same time.

Anyway, in the comments under that post, a Typical Type 1 (aka Jacquie) mentioned something that makes a lot of sense:

I’ve had to use it once. I drank some whiskey and threw up a bunch of food I’d just bolused for. I was low and dropping and drunk and knew I wouldn’t be able to keep anything down, so I did about half the vial. It worked quite well.

This made me thinking back to that Thanksgiving a few years ago where I got really, really sick (and over the next 24 hours, so did everyone else). But I was the first to be stricken, and I was so sick that my entire feast of a meal came back out the way it went in;  however the bolus I took for it remained. There was no way to get enough carbs in my system to neutralize the mega-bolus for the feast which I had enjoyed…twice. After swallowing (and then losing) nearly an entire tube of glucose tabs, I asked my family to drive me to the ER — so I could get some intravenous sugar before I slipped onto an even more dangerous low. Maybe a shot of glucagon would’ve helped – if I had thought of it (and if I had it with me).

If there’s one thing hospitals DON’T UNDERSTAND, it’s diabetes. When my sugar has finally shot up to 300 and they STILL want me to keep my pump disconnected, that’s when I become — yes, I’m going to use that word —  noncompliant. I’ll plug in, correct, and resume basal, and nobody with any amount of credentials or initials after their name can stop me.

So yeah, maybe I’m being stupid and/or stubborn and/or irresponsible. To tell the truth, I don’t see myself changing. I’ll try, and perhaps putting this in writing will bring some accountability. I want to make sure my wife knows how, comfortably, to use the thing, and I want to remember to bring it with me on vacation. But anything more is asking a lot. I’ll just try not to let my blood sugar get so low.

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Posted on June 20, 2013, in Diabetes, Personal and tagged , , . Bookmark the permalink. 6 Comments.

  1. it has been so helpful to hear about the glucagon beliefs of actual people!

    and even if you bring it with you on vacation, will you then also carry it to the beach from the beach house/on the hike/out to dinner?

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    • I suppose it’s all about playing the odds and determining how cautious we want to be. Some people follow the flight attendant’s rules and locate the nearest emergency exit, keeping in mind that the nearest exit might be behind them. Others tune out the safety-talk entirely and begin reading the latest issue of Cosmo.

      We each need to figure out what we’re comfortable with, and just be careful that we don’t slip too deep into that comfort-zone.

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  2. I’m in the Scott camp of glucagon use/disuse(is that a word?)….and no, even if I thought to take it on vacation (which, in almost 20 years, I never have) I wouldn’t be carting it all over creation with me. BUT, I feel like if I had a kid with diabetes, and maybe they weren’t as self aware of crashes, etc, I might. I’d be a horrible mom of a diabetic child. I admire you so much, Katy!

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  3. In 19 years with T1D, I have actually never used any glucagon kits (knock on wood). I have had maybe 4 and all expired and my hubby was just reminding me I need to get a new one since all mine have expired. I hope to never have to use mine either. So true about hospitals not understanding diabetes. Your Thanksgiving episode sounded scary, but good thinking to go to the hospital even if you did get high (better than an unconscious low)

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    • It’s a really awkward feeling asking to be brought to the ER without an actual emergency “in progress”. Then, once there, trying to explain and convince the triage nurse – while fully aware and coherent – that while it may seem that I just have a stomach bug, but if you don’t do something now, something bad is about to happen…

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  4. Never thought to use glucagon when sick or drunk. I thought it was only for someone who was unconscious! Good to know.

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