Glucagon saves lives in severe hypoglycemia! Is it for me?

By Ashlyn Smith, MMS, PA-C, DFAAPA, LSC

ELM Endocrinology & Lifestyle Medicine

Despite the similar name, glucagon is NOT glucose. Glucagon is a hormone that increases glucose levels by stimulating the liver to release emergency stores of glucose and to create new glucose. In a fully functioning pancreas, glucagon is produced in the pancreas and is secreted when glucose levels go low to protect the body from hypoglycemia. Essentially, glucagon is the opposite of the hormone insulin.

Glucagon can also be given as a medication to treat low blood sugar that does not respond to typical treatments with candy, soda, juice, or glucose tabs. Glucagon is a life-saving treatment for individuals at risk for severe hypoglycemia. Know your risk for severe hypoglycemia and if a glucagon prescription is right for you.

Severe hypoglycemia isn't a number--it's a state where you need help from someone else to treat and relies on glucagon treatment, not sugar or glucose tabs.

Understanding severe hypoglycemia

Hypoglycemia or “low blood sugar” is a condition where circulating glucose levels are lower than the safe range which can cause “adrenaline” symptoms (heart racing, shaking, sweating) and “neurologic” symptoms (confusion, seizures, unconsciousness). It is important to note that some individuals may not have symptoms due to conditions like hypoglycemia unawareness. The level of hypoglycemia corresponds to the risk of hypoglycemia:

·       Level 1 hypoglycemia: glucose less than 70 but no lower than 54mg/dL. Symptoms may be absent or may include racing heart, palpitations, shakiness, sweating, and anxiety. Treatment is with oral intake of 15 grams of simple sugars such as candy, soda, juice, or glucose tabs followed by a recheck of the glucose 15 minutes later (Rule of 15).

·       Level 2 hypoglycemia: glucose less than 54mg/dL. Symptoms may include mild confusion, difficulty concentrating, and weakness, but the individual is still willing and able to take food and drink by mouth. Treatment is with oral intake of 15 grams of simple sugars such as candy, soda, juice, or glucose tabs followed by a recheck of the glucose 15 minutes later (Rule of 15).

·       Level 3 hypoglycemia: does not depend on a certain glucose level, but is defined as the state of low blood sugar when the person is unable or unwilling to treat hypoglycemia safely by mouth. This may be due to a seizure, unconsciousness, severe confusion, or combativeness. At this level of hypoglycemia, it is unsafe to attempt any glucose treatment by mouth due to choking risk. Treatment requires outside assistance from support person, caregiver, or emergency medical services to administer glucagon and seek emergency medical attention.

Who is at risk for severe hypoglycemia?

Anyone at risk for level 3 hypoglycemia should be equipped with an emergency glucagon prescription. If you have any type of diabetes and have at least one of the following conditions, you are at risk for severe hypoglycemia:

·       On insulin therapy

·       On treatment with sulfonylureas (such as glipizide or glimepiride) or glinides (such as repaglinide and nateglinide)

·       Have had a previous episode of severe hypoglycemia

·       Lack of symptoms when glucose is less than 70mg/dL

·       Have kidney disease or low kidney function

·       65 years or older

·       Any memory difficulties

How does an emergency glucagon prescription work?

Anyone with diabetes of any type who has one of the above criteria should carry an emergency glucagon prescription at all times. Importantly, glucagon is typically given by someone who is NOT the patient, making it essential for those around the individual to be trained to use glucagon. This may be a parent, offspring, spouse, caregiver, teacher, neighbor, school nurse, etc.

Forms available:

• Injection kit: powder + saline, mixed then injected.

• Auto-injector pen: pre-filled, one-step injection.

• Nasal spray: needle-free, nasal application

  
  

Glucagon tips:

• Check expiration dates and replace any expired glucagon promptly.

• Store kits in key locations: carry glucagon with you when you are out of the home. Consider keeping multiple glucagon prescriptions in places you visit frequently such as home, work, a loved one’s home, school, or a neighbor’s home.

• Train family, friends, caregivers, and support persons on how to use glucagon

• Wear medical ID jewelry indicating diabetes or insulin use. It may be helpful to include the name and phone number of you “In case of emergency” contact and “Carries glucagon.” Some individuals have elected to use a medical alert tattoo with key information.

• If glucagon is used, call 911 to have emergency medical services evaluate the individual. Also contact your diabetes provider to let them know about the severe hypoglycemia episode to help prevent future episodes and to replace your glucagon prescription.

  
  

How I can help support you with the risk of severe hypoglycemia

·       I ask about hypoglycemia at every visit

Hypoglycemia can be stressful to the person experiencing it as well as their loved ones. Additionally, hypoglycemia can contribute to diabetes distress which we talk about here. By making discussions about hypoglycemia a normal part of your visit, we help to remove shame about bringing up hypoglycemia. Addressing hypoglycemia proactively helps prevent subsequent hypoglycemia and severe hypoglycemia, which significantly improves safe diabetes treatment. Yes, our conversations about the Rule of 15, severe hypoglycemia,  and the role of glucagon may seem repetitive but an ounce of preparation is worth a pound of cure. I would consider it a marked success if YOU are able to tell ME the Rule of 15 and the role of glucagon on our next visit!

·       I normalize hypoglycemia

Open-ended questions invite a safe space for conversations about hypoglycemia. While we want to address and reduce hypoglycemia, it is important to know that hypoglycemia is not your fault. It is not a sign of personal failure so there should not be any shame or blame. Hypoglycemia is a sign that your body is giving us to know where we need to adjust your treatment.

·       We work together on a safer diabetes plan

By collaborating together as provider and person with diabetes, we identify patterns and triggers of hypoglycemia as well as what helps stabilize your blood sugar. We partner the medical knowledge with the invaluable lived experience that you bring to identify the safest and most realistic next steps, whether that is to adjust medication doses, change medications entirely, adjust steps to reduce exercise-induced hypoglycemia, start continuous glucose monitoring, or some other safety measure to improve blood sugar stability and your comfort in managing diabetes. We will discuss the different preparations of glucagon to determine which is best for you and your support person, whether that is the familiarity of the injection kit, the simplicity of the autoinjector, or the needle-free nasal preparation.

Take home message:

Glucagon is hormone and life-saving emergency treatment for severe hypoglycemia. Any individual meeting the criteria above should wear medical emergency alert jewelry and carry an unexpired glucagon with them in the preparation that fits the needs and preparations of the person with diabetes and those around them. This may be the injection kit, auto-injector, or nasal preparation. Ensure the support people around you know where to find and how to use glucagon. Talk about hypoglycemia early and often. Hypoglycemia is not a failure, but a sign we use to adjust your treatment. By pairing medical expertise with your crucial lived experience, we collaborate on a safer diabetes regimen and a hypoglycemia safety plan that works best for you!

Have more questions about severe hypoglycemia? I am here to help—let’s connect on a free educational consultation to discuss further!

Access free educational resources for more information and tips here and even more here.

Disclaimer:

The content on this blog is for informational purposes only and is not intended to provide medical diagnosis, treatment, or replace professional medical advice, diagnosis, or care. Always consult a qualified healthcare provider with any questions regarding a medical condition or treatment.