There a lots of reasons why something like that can be experienced. Double down on a Dexcom often means the Dexcom is just dropping out; a spurious low report. I only treat when I experience the swoony, not before, and I only treat with fruit (well, I’ll do bread if necessary).
Baqsimi, or other inhaled approaches, should be the fastest but “fast” means getting to the liver (30-90s when inhaled correctly I believe) then activating the liver (releasing glucose into the major blood supply) and waiting.
Unless the veinous BG is being monitored it will take several minutes for a fingerstick or CGM (longer for a CGM) to get on board with the actual veinous BG. So our feelings, the swoon, should be faster. It doesn’t work that way for me, once I start to go low it takes many minutes after my fingerstick BG starts going up for me to stop feeling swoony. Maybe 10.
Hey! Use the Basqimi one or however it’s spelled. I don’t know how it works, but it’s like smelling salts. Whoever is helping you puts it near your nose, you breathe in, and you’re back. It’s simple, quick, and effective. It’s all I use today and fortunately I’ve only needed it once with a middle of the night crash in my sleep when I didn’t wake up. I’ve been type 1 for twenty-five years now, and that is my recommendation
Not sure but I got 4 syringes with 3 units out of it. I did leave a bit behind in the empty sterile vial. Even the smallest sterile vial I could by on Amazon was too big for the job.
I listened to Gary Scheiner(think like a pancreas author) say that 2 to 3 units of gvoke was equivalent to 15 carbs on adults. But individuals may vary so it was a good idea to test it out. So that’s what I did.
I’m not sure I understand the non-emergency micro dose approach to glucagon. Is it to avoid the calorie intake of treating with glucose? It seems like a glucose tablet or a teaspoon of dextrose would give a similar small rise in a pretty short amount of time
Microdosing glucagon is useful when eating glucose may not work. For example, when ill and vomiting, or when on a GLP-1 that causes delayed gastric emptying, or when delayed gastric emptying is a chronic condition perhaps because of nerve damage.
I don’t have gastroparisis that I know of and I’m not trying to avoid calories.
I’ve just been in a couple of crazy situations where I’ve eaten a large salad with protein and fat then had a tanking blood sugar about a half hour later. For me it takes a glucose gel forever to kick in with a stomach full of that sort of meal and just about all my willpower to not vomit. Those times have really frightened me so when I listened to the podcast about micro dosing I decided to get the prescription and load up some syringes to keep with me. The three units definitely worked more like 15 carbs not 1 glucose tablet.
I had a few glucogen kits floating around, but frankly me reading the instructions or someone else when I was having a problem seemed very intimidating. So I latched onto the Baqsimi as soon as it became available and got one for bedside, purse and the area I am in the most and made sure my hubby knows where they are and how to use. Easy would be highest priority for him if he ever had to use it. Huge problem…. The things expire and being a powder I’m not sure how much to trust a powder won’t cake over time? Especially since I am in a high humidity area which seems to affect everything. And they constantly expire, 3 at a time and I really don’t pay attention to that until I remember to look at some point. I’m really thinking of getting some Gvoke instead, If it’s prefilled, my hubby should be fine with it. But it expires, and I will have the same issues. If it’s me I read an article where taking glucose, especially under the tongue is faster than the glucogen release that happens when you use the hypo treatments, so for me I could care less if they are around, but my endo reminded me it’s in case I am unconscious or incapable and it’s for someone else to use.
It’s also a good point that a small dose of Gvoke could be used instead of waiting for the stomach to digest properly. I have noticed that as I get older my stomach digestion process is getting slower to respond. I gather that is somewhat common unfortunately in a type one as time goes on. So far it hasn’t been a problem, but eventually it could be.
Our ability to process glucose (and fructose) is rate limited; we can only process so much per hour. The paper I posted a while back (probably a couple of years) described the mechanisms for getting glucose from our gut into our blood stream, it was based on rats (never come back as a rat!)
I can’t find the link on Google even though that is where I found it before but that isn’t surprising.
The bottom line rate for rats was, from memory, quite high but in the g/kg range, so low enough that glucose might not cut it for an IDD with a serious OD. I have noticed that [product placement alert] Coca Cola, while it tastes like shyte, is pretty damn effective and very very cheap. Orange Juice is too (costs a lot more); it contains a moderate amount of fructose but also a similar and slightly greater amount of sucrose.
Sucrose, while it is a chemical combination of fructose and glucose, uses a separate pathway when it is ingested from the gut (this is what the paper I can’t find pointed out). If you need a lot of carbs go for sucrose or, for that matter, “complex” carbs; polysaccharides, to give the chemical name.
Generally liquids are better for me. If I throw up it’s because my stomach is full and angry; I can just drink more liquid after I’ve cleaned up the vomit. I don’t think it is a good thing not to vomit; I’ve watched dogs and humans do it over the years and they invariably feel better afterward. It’s harmless.
But since glucose and fructose use different substrates in the small intestine (SGLT1 vs GLUT5), and use different metabolic pathways (hexokinase vs. ketohexokinase), taking both is less rate-limited than taking only one or the other.
The general ballpark rate limit is around 90 grams per hour during exercise, but it can vary by the individual based on training, etc.
I want everyone to know about the “glucose under the tongue” technique. It turns out that glucose can be absorbed directly from the mucus membranes in the mouth, without needing to travel through the stomach to the small intestine. Chew a couple glucose tabs (or take a packet of glucose gel) but don’t swallow for 2 minutes. Instead swish the glucose around the gums and hold it under the tongue.
This is a useful technique in case of delayed gastric emptying.
@bkh Nice comment and reminder! I’ve read about this (glucose/sugars in the mouth and under the tongue) here on FUD (different topic title) and in other forums. Our training throughout life is to chew and swallow, so it can be hard to fight, taking conscious effort to hold a substance in our mouths. I’ve always remembered someone referencing a diabetes camp where instructors/counselors were trained on the technique for treating lows, to the point of putting tabs or gels in people’s mouths and putting them on their side to avoid aspiration (drowning) of the resulting fluids. Something to possibly give a shot (no pun intended) with your next low…
Simple sugars like glucose will pass right through the mucosa of the mouth. A cheap source of glucose is Karo white corn syrup without HFCS. Corn syrup is nearly all glucose (dextrose which is from corn) minus any water. 1 fluid oz = 15 or 16 grams of glucose. 2 tablespoons,
It is easier to hold in your mouth.
$3.00 for 16 doses or $0.19 vs $2.15 for Transcend gel.
I always keep a bottle of Karo at home and carry glucose tablets when out.
Thanks for bringing that up! I do this method when I’m at the gym all the time. In my experience it works pretty well with 1 glucose tablet but I don’t get anywhere near the 15 carb effect I’m looking for in a rapidly falling lower BG. It’s also a bit hard to hold an entire gel pack or 4 chewed up tablets in your mouth for any length of time lol
@Carlosluis Thanks for the idea of the Karo, hadn’t thought about it. I think there’s a bunch of us carrying a roll of glucose tabs (aka large Necco wafers) in a pocket or purse. I’m still using a 10 tab tube I bought a year+ ago! Refill it from a larger jar of glucose tabs as needed. I only fill it with 9 tabs, using the extra space for 2 Creon capsules in case we get food out (my pancreas decided to not only stop making insulin, but also stop making enzymes to digest fat, EPI [exocrine pancreatic insufficiency]). If I’m going further afield than about 30 mins, I take my kit with Baqsimi in addition to keeping one in both of our cars.
Ah, Tom, you’re in the same boat as Type 3c Pancreatogenic diabetes mellitus. This is caused by pancreatic cancer, acute pancreatitis, cystic fibrosis and damage of the pancreas by radiotherapy of a nearby cancer.
Pancreatic insufficiency is another diabetic complication we may acquire.
@CarlosLuis You’re right, mines due to chronic pancreatitis, without pain and dx’d after symptoms (really disgusting gas and diarrhea). Dana Lewis, of DIY OAPS fame, researched and found a correlation of 30% of T1s are afflicted to some degree so be on the lookout. Dx is a painless elastase test; normal=200+, <200=marginal, <100=severe…my score was 12! Yippie! Actually, some folks have severe stomach aches and cramps, which I do not, so I guess I should count myself lucky!
Sorry for departing from the purpose of this thread! Now back to the subject at hand!
Not a hijack at all; glucose tabs are the traditional doctor emergency med. Yeah, I know I have to have my glucagon kit but that’s really marketing because my wife understands how to stuff glucose tablets into my mouth but not how to combine these ingredients:
Despite Because of the extensive detailed instructions.
Oooh, thanks. That corresponds to about 10 units of insulin for me; that would be a big error, but it still seems possible to get into trouble. IRC the figure for rats was 4g/hour, but this really is from memory; I’m not sure if it was per-rat or per kg. I guess the latter; lab rats typically come in under 1kg. When I did the calculation before it didn’t scale up as a problem for a human but then I have no reason to believe it simply scales by mass. 100g/hour or 50g/hour (for just glucose say) is a lot more of an issue.
The on-the-side thing is universal CPR. A low BG isn’t the “CP” part of CPR but it is subject to the same issues; we salivate almost continuously and if the saliva goes down our throat the wrong way it can block the tube to our lungs.
It’s worth doing a CPR course. Yeah, I know in the US people are afraid of the legal liability if they are “trained” and do it wrong, but the training isn’t adequate to do anything right; it’s just adequate enough not to do something too wrong.
