Glucagon the Big Red Shot
”Just in case.”
“Keep it with you at all times.”
“You’ll probably never need to use it, but you never know.”
“Be sure you give the shot and THEN call 911 because EMTs are not allowed to administer Glucagon, and they’ve likely never been trained. Paramedics can, but EMTs cannot. They don’t even carry the drug with them. When the ambulance arrives they’ll probably be EMTs.”
“We know they expire within a year or two, and they cost a fortune, but you should probably have about 5 or 6 of them dispersed throughout your home, car, and school.”
“Oh, and don’t forget, there are multiple steps involved, and you have to go through a training to use it, but really it’s quite simple once you know how.”
“It will most likely make them violently ill, but they’ll be alive.”
There’s this scary thing parents get handed at the time of diagnosis. I was told each and every one of these things within a 5 minute span. They even make the carrying case scary and intimidating. Add a few ACME skulls and crossbones, and we’d all really be scared.
What makes it so scary though, beside its big red color and intimidating size and multi-step instructions, is what it represents and what every parent sees in their head when they push it aside while searching for chapstick in their bag. At least, I do. Every god damn time I look at this red shot my eyes well up and I see a seizing child in my head. It terrifies the hell out of me. And the damn thing is in every one of my bags, next to their nightstands, sitting in the medicine cabinet, in the glove compartment of the cars, stashed on the bookcase at my mom’s house, in Walker’s purse and Ollie’s camelback, tucked away in Marshall’s desk at work…..you get the point. The vision passes through me, and I get a pang of fear and adrenaline surge each and every time. But I can’t not have it in every corner of the house. Because, WHAT IF.
But then I think about how amazing this thing is and how at a time when I may feel the most helpless, there’s one last thing that can save their lives.
Glucagon is a hormone produced by the pancreas. It works to raise the concentration of glucose and fatty acids in the bloodstream. A person with Type 1 diabetes cannot produce glucagon, and therefore has no way to raise their blood sugar like someone with a fully functioning pancreas. So, if their blood sugar starts to drop, because of too much insulin in their system or having exercised or because they’re sick or a million other reasons, their body cannot regulate. In most cases you just give a fast acting sugar and all is well (ha, see how I make that sound so easy. It never is.) Anyway, in most cases something like juice or fruit gummies or glucose tabs will do the trick. But in the event that there’s a severe low, something that not even juice can lift, or the blood sugar is dropping too quickly, or they weren’t treating a trending low, or there have been multiple lows preceding this particular low, the body will start to shut down. And by shut down, I mean start to die.
A Glucagon shot is typically used when the person is unresponsive or seizing. Before that point we, as parents and loved ones of T1Ds, are told to use cake gel. Ask any T1D where their cake gel is, and they’ll probably say “right next to my Glucagon”. What you do is squeeze the entire tube of cake gel between their cheeks and gums, and rub like hell. Oh, what do I mean by cake gel? I mean that gross stuff you find next to the birthday candles and sugar letters in the baking aisle, the stuff you use to write HAPPY BIRTHDAY in blue script on your cakes. Cake gel is pure concentrated sugar and it gets into the system fast. Ask any parent of a toddler, it’s the stuff of birthday party nightmares.
So Glucagon is used when all other safety nets have broken. The reason we don’t go straight to the shot is because it sends the body into a frenzy. It’s quick and it’s dirty. At the “life saving” dose we’re taught to give, the glucagon forces the liver to dump its glucose reserve. It can take up to 15 minutes to work; I can only imagine what those 15 minutes must feel like. Once you administer the shot, assuming you caught it in time and the body is finally hit with this huge dump of glucose, the person will usually begin to vomit. And then there’s the many hours of rollercoastering blood sugars, headaches, upset stomach, and general endocrine upheaval. This is typically all overseen in the hospital, because constant intervention of insulin and dextrose drips are necessary to help get the person stable again.
Thank god, knock on wood, cross my fingers and hope to die, I’ve never had to use this shot on anyone. Marshall, in over 25 years has never had to use the shot. But I know many people who have. Multiple times. And it has forever changed them.
The “Glucagon Emergency Kit” as it is technically named, was approved by the FDA on November 14, 1960, 38 years after the production on insulin. Within the past year a new product has been made available, a nasal powder called Baqsimi, but ultimately still glucagon. It’s more user friendly, and somewhat less intimidating (just a point and shoot nasal spray). Here’s a video on how to administer Baqsimi. And here’s a video on how to use the big red shot.
