Last night we had a scare. If I am being honest, it’s always been my worst fear: a diabetes low blood sugar that is so LOW that my daughter doesn’t make it out on the other side. She’s almost 15 years old now and we’ve been dealing with diabetes for 12 of those years. As a diabetes mom, I try to be prepared for all of the things, all of the time. I can usually handle it, until something happens like last night. It happened so quickly that I fumbled and panicked. While our story has a happy ending, it needs to be shared so that you can be prepared for how to respond to an actual diabetes emergency.
My daughter has a summer job at a microcreamery ice cream shop at the beach. The shop is picture-perfect and she’s had the best time getting to know her coworkers while serving all of the tourists who make our home their home for one week at a time. She worked a five-hour shift from 5:00 pm – 10:00 pm and was on her feet the entire evening actively scooping ice cream and helping customers. Once her shift ended, I picked her up from work and started our 18-minute drive home. On the way, she happily counted her cash tip money and texted with her boyfriend.
A few minutes into our drive, I started to hear “the sound of my people” as diabetes alarms started ringing. The pod on her leg started beeping. Her PDM started beeping. The CGM app on her phone started beeping and then so did mine. All of the alarms, all at once. It was the urgent low alarm… the worst alarm of them all. Because I was driving and we were so close to home, I didn’t take the time to look at the actual number on the CGM app. I just kept driving. I thought that we would deal with the blood sugar once we got home. 18 minutes. That’s all that I needed and then I could fix the diabetes and we could go to bed. I quickly learned that I didn’t have 18 minutes. By the time I pulled my car into the driveway, my daughter was almost completely unresponsive. Her mouth was open and her eyes were fixed straight ahead. She couldn’t speak and wasn’t able to move her body. It was like she was frozen in place.
For 12 years, I’ve listened to our healthcare providers explain the importance of glucagon and how to respond in an emergency. I work for a diabetes nonprofit organization. I am surrounded by diabetes and people living with diabetes every second of my life. Even with all of that knowledge, when faced with an actual emergency, you are likely going to forget it all. All of the words, all of the suggestions, all of the tips and tricks to raise blood sugar. I panicked and knew that I needed to take quick action but felt like I was moving in slow motion. I was forgetting everything that I had learned as I entered the place of my worst nightmare.
Last year, Children with Diabetes hosted a lunch and learn on glucagon at a professional diabetes conference. After checking in our guests and ensuring the event was running properly, I sat in the back of the room and listened to the conversation about the rescue medication. At one point during the session, one of our speakers explained the importance of being familiar with Baqsimi. He held the tiny yellow tube up in front of the audience and flipped open the cap. He extended his arm and then activated the device by pushing down on the plunger and a puff of glucagon entered the air. It was a moment of diabetes magic. Without ever seeing glucagon in action, I had no idea what to expect with the product. This demonstration made the product real for me and took away the “scary” part of the idea of using glucagon. The speaker encouraged everyone to use their expired glucagon products in a practice session…before an actual emergency. Be familiar with opening it. Feel it in your hands. Learn how to administer it. Watch the puff. All of those steps would lead to greater confidence during an actual emergency. Now, in my own emergency, I remembered his voice and the demonstration and that magical puff.
I parked the car in the garage and called Ava’s boyfriend, Carson, on Facetime. I needed someone to help me “watch her” while I took my next steps. I shouted that we had an emergency and asked him to read me her CGM numbers from his Follow app. He responded, “all it says is LOW.” I quickly ran into the house and grabbed a box of Baqsimi glucagon. Her prescription at school was out of date and the school nurse needed a new vial for their supply closet. Just last week, I had the prescription refilled and the new box was still in our kitchen on the counter. As I ran back to the car, I ripped open the box and grabbed the vial and then panicked. I wasn’t even sure how to pop open the tube to get the medicine out. It was dark. The garage was hot. My daughter was frozen and diabetes was about to take both of us down. As I kept fumbling with the tube, I finally flipped it open and grabbed the device out of the tube. As I got ready to insert the device in her nostril, I asked Carson for an updated CGM number and he calmly told me “two more minutes.” I had previously taught him that the CGM numbers update every five minutes. Somehow, he was not only tracking the number on the app screen but also the time between the readings. He knew exactly how much time we had left before another reading would appear. I inserted the device in her nose and pushed the plunger in until I heard the medication release and the plunger stopped. I had done it. I glucagoned my daughter in an actual diabetes emergency.
I wish that this story ended here. I wish that I could say that shortly after the administration of glucagon, her blood sugars came up and all was well and we went to bed. That’s not quite how it all ended.
For those unfamiliar with glucagon, glucagon is a naturally occurring hormone in our bodies. Glucagon works by telling your liver to bring blood sugar back up to an acceptable range. For people with diabetes, in cases of low blood sugar, we typically think of glucagon as our last resort in our diabetes toolkit. Before resorting to the use of glucagon, we try to raise blood sugars with other methods like glucose tabs, juice boxes, sugary candy, and other combinations of carbohydrates and proteins. Ideally, glucagon should be used before you pass out but can be given after an individual has passed out from low blood sugar. There are different versions of glucagon available to patients with diabetes and the one that I used last night was the nasal glucagon, Baqsimi. The prescription includes a two-pack of medication and the vials are small enough to carry in your pocket, purse, or bag. This medication does not need to be refrigerated and can be used anytime and any place.
I’ve never had to use glucagon as a rescue medicine for the treatment of severe low blood sugar before last night. Throughout the years, I’ve used mini-doses of an injectable glucagon as part of our sick day management plan. Last night was different and while I thought that I was prepared to take on all things diabetes, diabetes wanted to remind me that it’s actually in charge of my daughter…and me. After administering the glucagon in the car, I imagined that my daughter would emerge from her “frozen state” fairly quickly and we could get on with our night. She didn’t. As Carson counted out the minutes and announced the readings from the CGM, she remained LOW. I came back inside the house and screamed for my son to come and help me. He quickly ran down the stairs and was able to help ease his twin out of the car by practically carrying her into the house and placing her on the couch. I ran to the kitchen and started quickly mixing up some chocolate milk with the hopes that she could drink and the numbers would start to rise. With each five minutes that passed, the blood sugar numbers remained LOW. The first dose of the glucagon wasn’t working. She wouldn’t and couldn’t drink the chocolate milk or take anything by mouth. I needed to take additional action. After screaming upstairs to wake my husband, I decided to grab my last remaining box of injectable glucagon and administer a mini-glucagon dose of a different brand. In this moment of panic, it never occurred to me to give a second full dose of the nasal glucagon. I never imagined that we would have to use glucagon in an actual emergency, much less two of them.
Looking back on the situation, I understand why the nasal glucagon prescription includes a two-pack of glucagon devices. This morning, I took the time to reflect and read the patient information leaflet on Baqsimi and I now understand that this version of glucagon takes about 7-8 minutes to begin working. It peaks after 30 minutes of administration and works for at least 90 minutes. If a person does not respond after 15 minutes, another dose may be given.
When in a crisis situation, the last thing that your brain wants to do is diabetes math. Thankfully, Carson was able to do the diabetes math and monitored the blood sugar numbers and the time between readings. My son remained close to his twin and quickly grabbed a bucket when the waves of nausea began. My husband waited, watched, and was prepared to call 911 if our efforts failed. We worked together as a team fighting against the diabetes that was trying to destroy us.
After the initial dose of nasal glucagon and administration of two mini-glucagon doses, the blood sugar number finally rose to 41. The time-lapse from the 18-minute car ride home to the point where we finally reached the 40’s was about 45 minutes. My daughter slowly started to move and emerge from her frozen state. It was going to be ok. We were going to make it.
I want our story to become your story.
As a diabetes mom, here are the things that I want you to know about using glucagon in an emergency. You may need to administer two doses. Wait 15 minutes to see if the first dose works. If not, administer a second dose. DO NOT BE AFRAID TO USE THE GLUCAGON. If possible, gather the troops and ask others for help. When providing care to someone who is dealing with a severe low blood sugar, you can’t do all of the things, all of the time. Assign someone to monitor BG numbers and announce those out loud while you are working to treat the blood sugar and provide care. Make sure that you have two doses of glucagon readily available and accessible to you at all times. Don’t just assume that since you are home and have access to traditional low blood sugar treatment supplies you won’t need the glucagon, too. We had it all…juice, tabs, chocolate milk, gummy clusters. None of that mattered in this situation. We needed the glucagon and thankfully could access it quickly.
I want you to know that it’s normal to have fears about diabetes and low blood sugar. I’ve had them for 12 years. I’m not paralyzed by this fear but, it’s always lingering and always in the back of my mind and the forefront of my heart. What saved our family last night was the fact that we had a diabetes emergency plan and we implemented it. Was it perfect? No. Did we do the best that we could at the time? Absolutely.
My daughter is fine today. She’s a bit groggy and tired but such is the way with teenagers in the summer. My son texted me this morning from his bed and his first question of the day was about his twin, “is she ok?” His words reminded me that while she is the person with diabetes, our entire family is affected by her diabetes in one way or another. I can’t imagine how afraid he must have been last night. Carson’s mom also checked in with me this morning to make sure that everything was ok today and to let me know how worried they all were about her and how much they loved her.
I’ve spent my whole morning re-educating myself about the use of glucagon and diabetes love-bombing my coworkers with diabetes so that they will be prepared for their own diabetes emergencies. I want you to be prepared, too. We are stronger when we share our diabetes knowledge and continue on this journey together through the highs and the lowest of lows.
Green and Orange Forever,
Leigh
Written by Leigh Fickling, JD, MEd, MS
