Although it may never have to be used, a glucagon kit is for a diabetes emergency, in particular for severe hypoglycemia, especially for people with type 1 diabetes.
The glucagon (to be injected into the person having a hypoglycemic episode) in the kit will raise the blood glucose levels when a person with diabetes is unconscious or uncooperative while having a severe hypoglycemic attack caused by low blood glucose.
The kit contains a liquid and a powder to produce glucagon; the powder must be mixed with the liquid in the kit right before it is injected.
The dosing is different for children and adults.
In general, if a child weighs less than 50 pounds (22.7 kilograms), half of the dose should be given; if more than 50 pounds, a full dose should be given.
But overall, the amount of the dose should be understood by the person administering it, whether family, a friend, or emergency medical technicians.
It is important that people with diabetes help their family and/or friends understand not only where the glucagon kit is located in the person’s home but also how to administer the glucagon.
In most cases, if emergency personnel are called when a person with diabetes has severe hypoglycemia, the emergency medical technicians will have such a kit. (Note: Also be aware that glucagon can induce vomiting.
If the person having a hypoglycemic episode has eaten recently, then it is best to keep his or her head turned, especially if the person is unconscious.)
Hypoglycemic patients might experience low blood glucose levels without warning, and sometimes without apparent reason. Having a glucagon kit can bring levels back to a normal range quickly.
Is the glucagon in a kit the same as glucagon naturally produced by the body?
Yes, the glucagon (also known as glucagen) in a kit is similar to the glucagon naturally produced by the body.
Like the natural hormone, it raises the blood glucose level by releasing glucose stored in the liver.
The glucagon in the kit is injected intramuscularly or subcutaneously and takes about ten to 15 minutes to work.
But there is one caveat: If the stores in the person’s liver are low, then the injected glucagon may not be effective.
In addition, if the person has been drinking alcohol to excess, has a very poor appetite (or has eaten a small amount of food recently), or had a hypoglycemic episode the day before, the glucagon may not work.
Is it possible to overdose injected insulin?
Yes, it is possible to get an overdose of insulin, although it is very rare if a person keeps careful tabs on his or her insulin injections.
In this case, an overdose of insulin causes hypoglycemia, or a very low blood glucose level, or glucose levels lower than 4 mmol/l (micromoles per liter).
In general, the symptoms of hypoglycemia include anxiety, confusion, sweating or clammy skin, trembling hands, extreme hunger, fatigue, or extreme irritability.
If levels continue to fall after an overdose, other more serious conditions can occur, such as seizures or unconsciousness.
Not everyone with diabetes experiences these symptoms with low blood sugar. (Although no one knows why at this writing, some people, most often with type 1 diabetes, have few symptoms as their blood sugar drops.
This is also why most health care professionals advocate that people with type 1 and 2 diabetes keep tabs on their blood glucose levels periodically throughout the day.)
Overdoses of insulin can occur in people with type 1 diabetes, as they have to inject the hormone into their system. It can also happen to the people with type 2 diabetes who inject insulin (usually because the blood glucose levels cannot be controlled by oral medication or there are changes in lifestyle, diet, or exercise). The following lists several ways in which a person with diabetes can get too much injected insulin:
• A person with diabetes injects the insulin but does not eat afterward. Blood glucose rises after a meal, and the injected insulin helps to lower it to a healthy level. If the person does not eat, the insulin can lower the blood glucose to a potentially dangerous level. This is why it is important to time insulin injections with meals.
• The person injects too much insulin. This may be because the person is not paying attention, is having difficulty reading the syringe or vials, or is not familiar with a new product for insulin injections. Once again, the extra insulin in the system will lower the blood glucose levels.
• The person injects the right amount of insulin but the wrong type. For example, short-acting insulin differs from long-acting insulin. If the person mixing the dosage usually takes ten units of short-acting insulin and 20 units of long-acting insulin but switches the amounts, the incorrect dosage can put too much insulin into the system. (For more about short- and long-acting insulin, see this chapter.)
What is GlucoGel™ (or Gluco Gel or glucogel)?
G lucoGel™ is the brand-name gel used by many people, including emergency medical technicians, to raise blood glucose levels quickly. It also provides a fast-acting energy boost to a person with diabetes. One of the reasons it was developed is that many diabetics having a hypoglycemic episode are irritable, hostile, and unreasonable. Many refuse to eat anything. The gel is easier to administer than food.
Formerly known as Hypostop, GlucoGel™ is a “sugar” gel (around 40 percent dextrose) that is mostly used for hypoglycemia and can be prescribed by a general practitioner or purchased over the counter.
It should be used only if the person who is having a hypoglycemic attack can swallow (there is the risk that an unconscious person will choke).
The gel must be squeezed from the tube into the mouth and between the teeth and cheek.
This is because the gel is absorbed by the lining of the mouth.
The person’s blood glucose levels should rise within 15 minutes.
After this treatment, it is advised that the person eat a starchy carbohydrate snack such as toast or a sandwich, then check blood glucose levels to see whether they have normalized.
If not, the above steps can be repeated as necessary.
How should a person treat an overdose of injected insulin?
There are several ways to handle a minor insulin overdose. If the person has injected a great amount of insulin, seek medical help immediately by calling emergency (911 in the United States). But in most cases, if a person is at home (and conscious), the following are some suggestions from several diabetes organizations in case of a minor overdose:
• Don’t panic.
• Check blood glucose level. (If it is very low, call emergency.)
• Drink a half cup of sweetened fruit juice and/or eat a sweet or glucose tablet. If a meal has been skipped, eat something now. For most people, eating 15 to 20 grams of carbohydrates should raise their blood glucose level.
• Rest, don’t walk or exercise. It will affect glucose levels.
• Recheck blood glucose level after 15 (some say ten) to 20 minutes after taking in the sugar or carbohydrates. Seek medical help if the level is unaffected by what was eaten.
• Pay attention to how the body feels for the next few hours. If the symptoms don’t improve or if other symptoms begin to occur, then seek medical help.
ANIMAL HELP AND DIABETES
What is the role of animals in the lives of humans, including some people with diabetes?
The role of animals is obvious to most people.
In particular, domesticated animals, from cats and dogs to hamsters, horses, and goldfish, give emotional support, help to lower blood pressure, and offer companionship.
Some special animals even help people with diabetes.
For example, there are specially trained dogs that help detect when people are experiencing high and low blood glucose levels.
Dogs can also be good for a person with diabetes to help promote exercise and provide social contact.
And because most dogs are “creatures of habit,” they can help a person with diabetes maintain a routine to monitor blood glucose and take medications.
What are Diabetic Alert Dogs?
A Diabetic Alert Dog (DAD) is trained to detect a hypoglycemic or hyperglycemic attack in a person with diabetes. During either episode, low or high levels of glucose in the blood, the body releases certain chemicals. The chemical scents are not detectable by humans but can be noticed by specially trained DADs.
How do specially trained Diabetic Alert Dogs help some people with diabetes?
Although not all people with diabetes can benefit from Diabetic Alert Dogs (and not all dogs can be alert-trained), the people who do benefit do so greatly.
Because one-eighth of a dog’s brain is composed of the olfactory bulb (tissue located at the front of the dog’s brain that processes scents detected by cells in their nose), dogs can be trained to recognize a single, distinct scent (this is why dogs are also used in such activities as police or forensic work).
These dogs do not take the place of monitoring blood glucose levels.
But they can detect and alert a person to changes in blood glucose levels or even alert others if the person with diabetes becomes incapacitated. (For resources on these dogs, including organizations such as the Diabetic Alert Dogs of America and Dogs 4 Diabetes, see the resources section at the end of this book.)
A trained Diabetic Alert Dog can detect, through its acute sense of smell, whether a person’s blood glucose is getting too high or low, often even before the patient can tell.
Who may need a specially trained dog to alert him or her to a high or low blood glucose level?
Not everyone with diabetes is a candidate for a dog trained to detect high and low glucose levels in the blood.
Therefore, people working with these dogs usually suggest that certain conditions be met to determine whether a person with diabetes is a good fit for such an animal.
For example, for people with diabetes using insulin or sulfonylureas (a group of medications used to treat diabetes), very low blood glucose levels can often be a major problem.
They need to be paired with dogs that can prevent such events as high and low blood sugar, warning the person if an episode is imminent.
This is done by exposing the dog to the smell of sweat or saliva from the person when his or her blood glucose levels are either high or low.
The dog is trained to alert a person to high or low blood glucose levels by a recognizable method, such as by nudging or touching the person with its paw.
Are all alert dogs specially trained?
Although most dogs are specifically trained to alert people with diabetes to high and low blood glucose levels, some other dogs seem to do the task naturally.
Stories about dogs adopted from a shelter that have helped their owners detect hypoglycemia or hyperglycemic episodes have been reported, but it often takes a special type of dog to take on such a task.
This is why, if a person with diabetes wants a diabetes alert dog and already owns a dog, he or she may want to enroll in a workshop in which the person can learn whether the dog is suitable.
Most diabetes alert dog trainers also note that although a puppy can be trained as an alert dog, it probably will not be a reliable one until it is at least a year old.
Why do dogs have such a keen sense of smell, especially in comparison with humans?