“We Used Mini-Doses of Glucagon Because of a Stomach Virus.”

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A patient advocate with two daughters with T1D discusses how glucagon kept a daughter out of ER.

-Amy Ohmer/Natsweetsisters

When it comes to taking care of children with type 1 diabetes who are sick, it can be challenging to know when you need to head to the emergency room and when you can stay home. (That can be true, too, for adults with type 1 diabetes.)  

Much of how we decide whether or not to go to ER comes from a combination of science and instinct. As a parent, I‘ve found that both are critical to keeping our two daughters with T1D happy and healthy.

One time, my youngest daughter arrived home from elementary school saying she felt tired.  Skipping her typical afternoon snack, she went into my bedroom to watch TV and snuggle under the covers. Immediately, a few red flags began to pop up in my head, as this was a child who loved nothing more than to be busy and active. She was quiet later, as well, as she picked at her evening meal.  

As I was clearing plates, she wandered back into the kitchen, visibly shaking – one of her common tells of a low.  We checked her CGM and it showed a sharply declining 53 mg/dL. Knowing that this reading came right after she had eaten, and understanding that I had dosed very little insulin, I handed her a 14-carb juice box while I considered the situation.

Immediately after taking her first sip of juice, she began to complain of stomach pain. We did a urine-based ketone check, but it was negative. It was only then that I remembered a school note warning that a stomach bug was going around the school. That meant my daughter might not be able to keep any carbs down to cover the insulin in her system.

A blood glucose level of 53 mg/dL isn’t low enough to warrant a full injection of glucagon, but I remembered that there might be a way to utilize just enough glucagon to stop a low from becoming more severe.  I was pretty sure she was in the beginning stages of the stomach flu, and I wanted to create a preemptive way for our daughter to be sick safely without having to battle dangerous lows.

And just like that, my mind went blank on the science of how many units of mini-glucagon to dose.

I called my daughter’s endocrinologist, who gave me the correct dosing size. I then mixed the glucagon according to standard directions, but used one of our regular insulin syringes to dose and inject into her upper arm.

Slowly, her color returned and she became more expressive. I soon felt relieved enough to tuck her into bed. I continued to check her blood glucose every hour and it stayed stable at around 125 mg/dL.

It wasn’t exactly a peaceful night, as around midnight the vomiting began, but with mini-glucagon on board, I was able to comfort her through her sickness just as I would have done before diabetes entered the picture.

Here are five ways to prepare for a sick day with type 1 diabetes:

1.)   Create a sick day plan with your endocrinologist.

2.)   Bookmark a good online diabetes sick-day website on your phone, computer, or tablet for reference. (For example, the University of Michigan, C.S. Mott Children’s Hospital Pediatric Endocrinology Team has a good site you can find here.)  

3.)   Print out a list of emergency contact numbers and post them on the inside of your kitchen or bathroom cabinet.

4.)   Always have ketone strips (urine or blood) available for immediate use and keep your low supplies, including glucagon, stocked and ready.

5.)   Know when and how to use your lesser-used diabetes management tools, such as glucagon.

While this information has been reviewed by medical professionals, every sickness with type 1 diabetes can be different. Please call your endocrinologist and/or go to the Emergency Room for treatment if you feel it is warranted.

Amy Ohmer is a notable type 1 diabetes advocate who blogs about her experience as a D-mom at http://www.naturallysweetsisters.com/

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