A Low Point in My Life: Talking Extreme Lows and Glucagon

Short Description
How glucagon innovations can improve your safety at college
Contributor
Laura Poole, Elon University alumna

Glucagon Series Sponsored by Xeris Pharmaceuticals, Inc. & Lilly Diabetes: Blog #1 - tackling the burden of self-advocacy and education.

Disclaimer: This blog is part of a series of blogs written by CDN students, alumni, and parents. CDN is committed to ensuring that young adults have the information they need to make informed choices about their healthcare. Given the recent innovations in glucagon, we wanted to highlight stories from our network about past experiences with lows, and how new treatment options are impacting their plans for future lows.

When I left for college, I would look in magazines and online for the “college essentials” checklists so I made sure I didn’t forget a single thing. But none of these checklists had the true, life-saving essentials I needed to be a functioning college kid with type 1 diabetes. I made plans with my parents and my doctors; I knew exactly what to bring and how to organize it all in order to feel best prepared.

When I moved in, I told all of my roommates about my little annoying friend I call diabetes so they would understand when they heard weird beeping noises at odd times. I was used to handling it; I had been for more than half my life. So, I downplay the severity of how much of a burden or a struggle it can be. I say things like, “Yeah, so this little red box is glucagon, a hormone that raises blood glucose. So, if I ever have a really bad low blood sugar and seize or become unconscious, you just mix the solution and give me a massive shot!” I say the entire thing like it’s an improbable joke.

However, there have been a few occasions where this was not an improbable joke, and that is why my annoying little friend can be so terrifying. During my college years, I had four different episodes of bad lows. One episode landed me in the hospital, and all landed me in tears and left me terrified for days following.

 

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"In her anxiety, she had forgotten where I said the glucagon was kept, so she called my mom. My mom had always been told that glucagon is the last resort option; try everything possible before it."

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I grew up going to diabetes camp, so I have a wonderful support system in dealing with the hardships we all face. Growing up in this environment allowed me to feel like I should never hide my disease, but rather that I should be very open about it because that could save my life. So, I told the strangers I was randomly placed with freshman year about my annoying little friend, diabetes. Most of them didn’t care. One of them, Sam, became one of my closest friends that first semester. She listened and asked me questions about diabetes.

On one particular Thursday, she came bouncing into my room to see if I was ready to head over to yoga. I was unresponsive. I had gone to bed around midnight and at some point during the night, my blood sugar had dropped to dangerous levels. Since I was asleep, it was much harder to wake up and correct the low. My Dexcom alarms were going off, but my phone had fallen

between my bed and the wall. It was covered by the blanket that had been pulled down with it; it was the perfect storm for no one to notice.

Sam thought I was sleeping, maybe taking an afternoon nap as many college kids do. So, she jokingly yelled for me to get my lazy butt out of bed and get ready for yoga. When I didn’t wake up, she shook me. When I still did not respond, her heart dropped. This was one of those scenarios I had warned about. In her anxiety, she had forgotten where I said the glucagon was kept, so she called my mom. My mom had always been told that glucagon is the last resort option; try everything possible before it.

 

Blurb Title
"As companies work to improve the daily lives of people with diabetes, new innovations for glucagon have been helping put our fears of handling bad lows at ease."

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With my mom on the other line, Sam did everything she could to avoid giving me glucagon via a huge needle. She propped me up, I was barely responsive and slurring my words trying to tell her what she needed to do. My mom told her to find some juice or soda. She found a cup and a straw and tried to coax me to drink it. I felt like I had a space helmet on and drinking soda out of a straw was not easy. I was confused and made no sense. She knew this was bad, so even with my mom’s help and encouragement to finally give me the glucagon, she just couldn’t give the shot. What if she mixed the solution wrong? What if she gave it to me wrong? What if I flinched or she made me bleed? Luckily, one of our other roommates had called EMS.

EMS came and gave me glucagon and waited to take me to the hospital until I was mostly conscious. My blood sugar was below 20 when they checked me the first time. They kept telling me I was lucky Sam had been there or I may not have made it. My cognitive functions and motor skills were temporarily impaired. It was hard to walk and write for the next few days.

I called my endocrinologists and figured out how to change my settings so I would run higher after that. I never went to bed below 150, and I always made sure to have extra juice and fruit snacks next to my bed. And I kept the little red box of glucagon right next to my phone every night. I still get scared some nights that something like this will happen again. On the nights I am home alone, I make sure I have people in place to call me by a certain time if they don’t hear from me.

As companies work to improve the daily lives of people with diabetes, new innovations for glucagon have been helping put our fears of handling bad lows at ease.  One anxiety for those administering the old glucagon, can be the needle. It is large, and for someone not accustomed to giving injections, it can be daunting. People may not have the same fear when administering another life-saving drug, like pens used for allergy attacks, but the person giving the shot never sees the needle and doesn’t have to manually place it in the skin. My mom told me that she couldn’t bring herself to give me the injection for fear of hurting me. Sam had the same concerns. Looking at a large needle knowing you have to place it in the correct spot in skin is normally a job left to healthcare professionals. In a high-stress moment, it is one of the most terrifying responsibilities.

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"These become added options to help diabetics and their loved ones combat severe lows – while also putting families and students at ease when moving away from home and living on their own for the first time."

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Two new products have recently been released. One revolution is a ready-to use glucagon prefilled syringe and auto-injector. This new technology could take away the needle fear and the anxiety of having to mix the solution in an already-stressful situation. Mixing might seem like a simple step, but it is an added stressor in a high-pressure moment for individuals administering the shot. If the patient with the low is administering the shot, it may hard to mix the solution with shaky hands from the low. The premixed solution takes away some of that fear. It can be a way to avoid the severe low if you administer it early enough, and as someone who has given myself a shot of glucagon preemptively, it would be a huge help.

Another new option is a nasal glucagon. This innovation is a simple three-step spray, no mixing required. With products such as these diminishing the fear during an often-terrifying event, glucagon becomes a more accessible product to use. Improved technologies continue to make glucagon an important tool to have around, but take away the “last resort” feeling and give confidence to caregivers administering it. These become added options to help diabetics and their loved ones combat severe lows – while also putting families and students at ease when moving away from home and living on their own for the first time.

I hope to one day be a part of these constantly improving innovations and technologies professionally so that no one will have to feel this constant fear any longer. In fact, after attending an advisory board where I talked about experiences just like this one, I learned about a whole new world of diabetes-related professions. I changed my major to statistics so I could utilize my skills to implement technological and medical innovations; I can put myself and others at ease little by little. Diabetes has a lot of low points, but I am determined to look at the good side and make changes for the better going forward.

 

Editor’s note:

For more information on the new glucagon options that Laura discussed, please visit the Gvoke website (premixed autoinjector option) and the Baqsimi® website (nasal option).

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Laura headshot
Description

Laura is a recent graduate from Elon University with a major in statistics and minors in creative writing and psychology. She was the president and founder of the Elon CDN Chapter, the Dead Pancreas Society.