Glucagon Mini-Dosing | A Valuable Tool

Breakfast with Santa is something we all look forward to each year. It is simply magical to see any doubt my kids may have instantly vanish when Santa and Mrs. Claus approach them and say, “Hey, I hear you guys (insert actual fact about their lives that the Claus’ would have no way of knowing unless they were indeed real).”

Usually, Santa makes his first appearance after we are settled and have begun eating. He wanders around the room and makes small talk with everyone. After a little while, he and Mrs. Claus call the families up one by one and meet with them personally.  This year, for the first time, Santa was there and ready to go when we walked in.  We not only had a casual chat at our table, but were done with our personal time with the Claus’ before breakfast was even served.

Everyone looks happy, don’t they?

As we headed back to our seats, Caleb said his belly was bothering him. It was more than a hour after our normal breakfast time, so I attributed it to hunger. I asked him if he was ready to eat, to which he replied, “yes”, and I bolused. Pancakes were retrieved and Caleb began eating.

Caleb ate slowly and very little. He decided that the sight and smell of food was unappealing. He took a sip of juice and waved that away too.

I had just bolused him with 4 units of insulin. 4 units is about twenty percent of Caleb’s total daily dose.

I coaxed him to drink his juice – maybe the insulin was kicking in and he’s starting to feel low and a little boost will make him feel better.

It didn’t. He heaved.

At this point David and Colin had left for another commitment of Colin’s. Lila was distracted with various Christmas crafts.

I quickly swept Caleb away to the bathroom and anything he had just ingested came back out like a fire hose.

“No need to panic”, I told myself.

Caleb felt better after getting all that up. Maybe this was just a one time thing and he would have his appetite back.

No such luck. He threw up 2 more times over the course of the next half hour.

I knew the urgency of the situation. I knew I might need to get him to the hospital for a glucose drip and intravenous hydration. Still, there was no panic. I had the benefit of knowing a course of action that could avoid a trip to the emergency room.

Mini-glucagon.

I distinctly remember the details of Nan’s story in a similar situation. I remember how alarmed I felt when I read it the first time, picturing her and C going through every single step. The thought of using glucagon in mini doses that way was a new idea to me. I only had the frame of reference we were given when Caleb was diagnosed:

  • Use glucagon in an emergency only.
  • Use glucagon if Caleb has a severe hypoglycemic episode and can’t eat anything.
  • Try squeezing glucose gel in his cheek first.
  • Use glucagon if he’s unconscious and nothing else works.
  • Use it as a last resort.
  • We hope you never have to use it.

But thanks to Nan’s story, I knew that glucagon could be used in a less severe, though equally urgent situation. I pulled it out and put it on the table. I explained to Caleb that if he couldn’t eat, I would be able to cover the bolus with a shot. After a few more attempts to drink, he looked at me and said, “Mom, let’s do the shot.”

So that’s what we did. He pulled up his sleeve and I injected him with 5 units. Almost instantly, he looked better. He was soon feeling better and able to do a craft with his sister.

After a little while, a fingerstick of 89, and quite a bit of insulin still working in him, I gave him another injection of 5 units.

We finished everything we needed to and Caleb seemed to be at a safe blood sugar for transport. So we made our move.  If anyone around us had a clue what was going on, they didn’t make it known.

We got home and I tucked Caleb into bed and made him comfortable. He was a safe 134 and we were out of the danger zone.  He was able to keep down enough fluids to stay hydrated and his blood sugar remained stable.

Thank you to my friends who have shared their own glucagon stories and thus given me the confidence and composure to handle this. Without the benefit of your combined stories, I’m certain things would have gone very differently.

I thought I would never want to be part of the “Glucagon Club” but in fact I am glad to be in it. Given the circumstances of that morning, mini glucagon seems like an easy fix compared to any other alternatives I can think of.

Lastly, and maybe most importantly, thank you Santa for being early this year.  Someone was watching over us to make sure that we could have that moment of joy. Our memory of that morning is mostly of our meeting with Mr. and Mrs. Claus which just happened to be followed by an unfortunate series of events. Had we eaten breakfast first like we normally do, those pictures above would be at least one person shy.

For more information on glucagon, here are the resources and stories that prepared me:

Note: the recommended dosing for mini glucagon is as follows:

  • ages 2 years and under: 2 units
  • age 2 to 15 years: 1 unit  for each year of age (6 units for a 6 year old, etc.)
  • age 15 years and older: 15 units

I used a standard insulin syringe (not the harpoon included in the kit).

Caleb’s recap of these events is here.

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29 thoughts on “Glucagon Mini-Dosing | A Valuable Tool

  1. If you use a regular needle… do you just put it subcutaneously and not into a muscle like you do in an emergency situation?? I just want to be prepared if I need to do this.

    • I’m not sure what the recommended course of action is. I just did what I know without giving it much thought – I pinched up the back of his arm and injected it the same way I would have injected insulin.

  2. I wish I would have known about this a few weeks ago – maybe I could have avoided an ambulance ride! Well, I’m glad I know it now & I’ll be letting people close to me know about it as well! Thanks once again Lorraine – I get the best information from you!

  3. How scary! The internet is a wonderful thing. I’m so glad you have a group that shares this info so you could be composed when a situation like this arises. Glad Caleb was able to enjoy the rest of the morning.

  4. Wow, what a scary situation! That is so great that you knew how to handle the situation. It’s making me realize, though, how unprepared I am for things like this. I don’t usually keep glucagon with me at all times, but maybe I should!

  5. My heart was racing as I read this! Wow! You handled this beautifully. I’m tucking this info into my brain.

  6. Thanks for posting! We’ve had to use the miniglucagon a few times with our toddler, and the first time was as scary – and gratifying – as you described.
    A few thoughts –
    * You can use a regular needle to inject a mini dose subcutaneously (no need to use the huge one in the kit)
    * Glucagon can cause nausea, so best not to eat/drink for half an hour afterwards
    * We turn the pump down -50% or so until blood sugar starts coming up (or off, in really severe cases) – easier to correct down than up when throwing up’s involved. A stomach bug sometimes requires reduced basal (and I;C) for days anyhow.
    Great blog – really appreciate the informative posts!

  7. such an informative post Lo!!!! Yay!!! Oh, I’ve been mia lately, big-time! i will come back and leave a more detailed comment later…but just had to say how honored i am to be mentioned here!! (and i love the falling snow on your blog : )

  8. I, too, thought the same thing as Alexis as I read this post.

    HA! Take that D!

    I loved you included photos of the event and just how normal healthy Caleb looks just minutes leading up to puking. It is sooooooo true to life! I am always amazed at how kids can be fine one moment and sick as a dog the next.

    This post also puts me to ease about carrying the glucagon in our ‘going out’ bag. My husband thinks I am overly cautious, but I know how quickly things situations can become emergencies and this post shows how the glucagon can be used in another very helpful manner.

    I’ll bet the insurance company woudl LOVE to hear about this. 😉 You avoided an ER visit and probably a couple grand billed. Nice work.

    You nerves of steel are giving me hope, Lorraine. Thank you!

  9. thank you for sharing.. I have sent with all the people who may be in the care of Joshua one day so that they are aware as well. I would not have know how to use it very well.
    THANK YOU so much for this information

  10. Great post! Very helpful info. I carried that rescue kit with the huge needle in my purse terrified of it for years. Time to get a new one and not be afraid!

  11. Great post Lorraine.

    I am glad that Caleb recovered nicely. I sounds like you did an outstanding job of keeping your cool friend! You rock as a pancreas…and as it’s side-kick the liver!!! WOOT.

  12. MAN! I wish this would have been written Friday. I had a very similar situation with the pre-meal bolus and then getting sick. My #bgs went down to 30 it got VERY SCARY. We had the glucagon at the ready if I lost consciousness but didn’t use it.
    I happened to be at my parents (and let me tell you that even at 32 i was VERY glad to have my mommy there) and my mother suggested a partial dose I didnt think it was possible. Thanks for the info

  13. Oh MY! I am soooooo glad that you were able to visit with Santa and the Mrs. Early and that Caleb didn’t have to miss out on that. Scary. But thanks for sharing. The more I read about it, the comfortable I feel that I could do it if I had to. I hope he’s feeling better now!

  14. Yay for avoiding what could have been an even worse situation.

    I wonder if we could have avoided the ER a few weeks ago by doing this. The on call endo at 1 in the morning didn’t know the correct dosage/procedure and didn’t have the info in front of her (boo).

    I never carry syringes anymore. I always carry Glucagon. I may have to find a small syringe holder and keep one in our little bag.

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  16. I’ve never owned glucagon primarily because of the directions they give for us (last resort). I live alone, so basically my thought is that if I am low enough to need to use it, I am too low to actually use it.
    A mini-dose is something that might actually be helpful, and might actually convince me to fill the prescription I keep getting.

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  19. Quick question on the mini dose- once the glucagon has been mixed and used, I assume it is recommended that it be thrown out? Do you know the shelf life once it has been used once? After a nasty bout of stomach flu, we battled epic lows for several days afterward. Do you think the mini dose can be used a few times over a couple days? Just curious.

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