Hypoglycemia Preparedness: How to Know Before You Go Low

This content originally appeared on diaTribe. Republished with permission.

By Lorena Bergstrom

A new awareness campaign helps people with diabetes recognize and plan for low blood sugar with emergency toolkits, discussion prompts, journaling, and a support network  

Low blood sugar can be a scary thing – it often sneaks up when people least expect it, quickly shifting from a minor annoyance to a potentially dangerous situation. In fact, a Canadian study found that people with diabetes (type 1 and type 2) experience severe hypoglycemia an average of 2.5 times each year. While type 2 diabetes typically presents a lower hypoglycemic risk than type 1, insulin and oral medications can still cause low blood sugar. However, you can take many steps to protect yourself.

We spoke with endocrinologist Dr. Gregory Dodell (with Mount Sinai in New York) and singer Crystal Bowersox about Lilly’s new Know Before the Low campaign, an important initiative to raise awareness about hypoglycemia. Bowersox and Dr. Dodell hope this program will empower people with diabetes to recognize signs of low blood sugar, start conversations with their peers, and prepare for emergencies before they happen.

Dodell

Image source: diaTribe

Know Before the Low offers information about managing hypoglycemia; it includes a chart of physical and cognitive symptoms, a tip list for emergency planning, and a guide for building a support network. Dr. Dodell said that unfortunately most diabetes literature focuses on controlling high blood sugar – even though low blood sugar can be more dangerous. He said that the campaign aims to address this information gap by “helping people and healthcare professionals talk about low blood sugar and prevent future episodes.”

To start, every person with diabetes should build an emergency toolkit, including:

  • Glucose tablets or sugary snacks
  • Glucagon – read about emergency nasal glucagon (Baqsimi) and ready-to-use autoinjector pens (Gvoke)
  • Glucose monitor (continuous glucose monitor or fingerstick blood glucose meter)
  • Emergency contact information

Bowersox makes her emergency pouch easily accessible to her friends and family: “My family, including my 11-year-old son, knows what to do if I have a hypoglycemic episode or emergency. I think it’s important for an individual’s entire support network to be aware of this.” Of course, it may seem inconvenient to carry around an entire toolkit when going out, but many of the new glucagons (like Gvoke and Baqsimi) are much more portable and easier to use than the glucagon previously available.

Keep in mind that for many people with diabetes, nighttime is both the most dangerous and the most common time to experience hypoglycemia. Dr. Dodell shared some useful advice: “If you see a downward trend before bed, you should eat a snack. It’s better to wake up high and correct during the day than have a low blood sugar episode overnight, which could cause many more complications and inconveniences. It’s also important for people with diabetes to know the triggers that can cause lows at night.” In short: check blood glucose before bed, play it safe, and know your risk factors. Additionally, daily routines have changed during COVID-19; you may be eating different foods, exercising more or less, and experiencing higher stress. All these factors may affect your blood sugar, especially at night.

Everyone’s body is different, but common risk factors for hypoglycemia include:

  • Exercise
  • Too much insulin
  • Fasting or low carbohydrate intake
  • Alcohol
  • Medications
  • Stress
  • Hormonal fluctuations
  • Illness

For a full list, check out Adam Brown and diaTribe’s 42 factors that affect blood glucose from his book Bright Spots & Landmines.

Hypoglycemia is different for everyone, so it is essential to be aware of your own body. Try to observe the symptoms you experience, and make note of potential triggers. Bowersox recommended keeping track of patterns: “Keeping a log or journal of things such as physical or emotional activity and comparing it to your blood sugar data could be a good way to see if there are trends that are causing you to go low. Ultimately, it’s important to share that information with your support network.” Know yourself – there are many factors that can lead to hypoglycemia, so it’s important to learn your own patterns of low blood sugar so that you can avoid these experiences.

KBTL

Image source: diaTribe

Perhaps the most critical part of Know Before the Low is its emphasis on connecting with your support network – family, friends, coworkers, teachers, and others. Bowersox said that she once had to ask her audience for candy to raise her blood sugar; fans were supportive and thanked her for raising awareness about diabetes. However, it can sometimes be difficult or uncomfortable to start conversations about diabetes and hypoglycemia with the people around us. Dr. Dodell explained that keeping the dialogue casual yet informative can be an opportunity to teach people something new: “You’re not putting a burden on them, but just explaining how diabetes affects your life. By broaching the topic casually, you can treat the conversation as more of a heads up than bestowing a responsibility. Just make sure to explain that you are carefully managing your diabetes, but there is a chance of an emergency. Not everyone has met someone with diabetes, but just explaining it and educating them can be a great preventive step.”

By sharing information about hypoglycemia signs, symptoms, and treatments, you can empower your peers to step in during an emergency. As Bowersox said, “Knowledge is power! When your network has information, they are empowered to help you, especially with low blood sugar. When I travel, my quality of life is improved by just educating and speaking up. Practice with your mirror, practice with your pet, but make sure your support network is there for you.”

As this project raises awareness of hypoglycemia, we hope it encourages people with diabetes, their healthcare professionals, and their support networks to engage in valuable discussions. As Dr. Dodell so perfectly concluded, “This campaign is one of the first to address the dangers of hypoglycemia. It is groundbreaking, and allows people to get needed resources. Diabetes experts and endocrinologists know that high blood sugar can sometimes be better than low blood sugar.”

For more information, read diaTribe’s article on hypoglycemia unawareness.

Source: diabetesdaily.com

Why Glucagon Is a Must for Sick Days

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Dakin

Common Knowledge

Becoming sick when you have type 1 diabetes can easily complicate things. When you have the flu or a serious bacterial infection, your blood sugar levels can quickly become harder to manage, as they typically trend higher because of your body’s automatic, hormonal response to being sick. Because of this, you might find yourself needing more insulin than usual and needing to check for ketones more often to prevent diabetic ketoacidosis (DKA). Having a plan for sick day management when you have type 1 diabetes is crucial.

It’s important to be mindful of the possibility of high blood sugar when you’re sick. But it is also important to realize that sick day lows are a definite possibility as well! Especially if you’re taking more insulin than normal to combat highs when sick, you have to be mindful of resulting lows. You also run the risk of encountering a severe low if you are either unable to keep food down or lack an appetite when you’re sick, which are common realities when you have a cold or flu.

Enter Glucagon

Whatever the reason for a low, keeping glucagon handy to combat severe bouts of hypoglycemia on a sick day is definitely a must. Severe hypoglycemia is a dangerous complication of type 1 that can result in seizure, loss of consciousness, or death, and there is peace of mind in having a safety net to prevent any one of those outcomes. Glucagon is the first line treatment for severe hypoglycemia because it is the main counter-regulatory hormone to insulin. Parents and caretakers of those with type 1 can especially benefit by having an immediate safeguard against the dangers realities of a severe low.

The standard of care has been to keep a glucagon emergency kit handy. Historically, these emergency kits came equipped with an injectable form of glucagon, that requires mixing powder and liquid with a syringe by whoever is administering the shot. While this can definitely be an effective form of glucagon, having to mix the shot prior has made the procedure complicated and intimidating for some.

Next Level Options

Luckily for those of us affected by type 1 diabetes (T1D), glucagon has been approved in two new forms over the last year: nasal glucagon and pre-mixed steady state.

Baqsimi is the first and only nasal, non-injectable form of glucagon, offering a slight variation on what most people with diabetes are used to. It is administered like a nasal spray, but does not require inhalation, so even if a patient is unconscious (a frequent cause of severe hypoglycemia), anyone can administer Baqsimi and it will work.

Gvoke is the first liquid stable form of glucagon, meaning though it is an injection, it comes ready to use and requires no mixing on the part of whoever is administering the shot. Gvoke also comes in two forms: a pre-filled syringe (called Gvoke PFS) that is available to patients now and an auto-injector pen (the Gvoke HypoPen) that has yet to become officially available.

Neither Gvoke nor Baqsimi require refrigeration, and both have an impressive shelf life of up to two years if kept at room temperature. Another added benefit of these next generation iterations of glucagon is that these tools can likely prevent an ambulance trip to the hospital, saving time and resources. (Editor’s Note: This is especially important during the current COVID-19 pandemic, as it is not advised to visit hospitals unless absolutely necessary.)

How to Get Glucagon

Lilly currently offers a Baqsimi coupon patients can use to get up to two devices for as little as $25.

Through the end of April 2020, Xeris is offering a Gvoke co-pay card with which some patients can pay as little as $0 with eligible insurance to get their Gvoke PFS. Patients can also opt to request their prescription through the website and have Gvoke PFS delivered by PillPack at no additional cost.

Keeping glucagon handy is the best defense against unexpected lows when you’re not feeling well. Being sick might come with some uncertainties and cause some worry, but you can rest easier knowing you’re prepared and equipped with the necessary tools to take on whatever comes your way.

For step by step instructions on how to use each type of emergency glucagon, click here.

Source: diabetesdaily.com

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