Tag Archives: hypoglycemia

Looks can be deceiving.

March 17, 2014 – 9:40 am

I had a wierd high and a strange low in the past four days. Neither fit the stereotypical low or high.
 
 
Thursday night at about 3:00 a.m., I found myself with a very dry throat and an overwhelming urge to use the bathroom. When I came back, I did a quick BG test to find a 53 mg/dL staring me in the face. Not a common occurrence.
 
 
Sunday, the tables were turned. I had completed a hard hour-plus workout at the gym. I spent extra time to recover and drink lots of water to rehydrate my muscles. Apparently, it wasn’t enough, because when I got back into my truck, a quick test revealed 260 mg/dL as the result. Probably too low of a temp basal during the workout, and I was still dehydrated.
 
 
Moral of the story: Things are not always what they may seem. And test, test, test.
 
 
 

By StephenS | Posted in Diabetes | Also tagged , , | Comments (1)

Weird middle-of-the-day low.

November 25, 2013 – 9:22 am

On Friday, Mike Hoskins over at Diabetes Mine wrote about how hypoglycemia (low blood glucose) feels to him. If you have diabetes, you have your own experiences with hypoglycemia. Nearly everyone’s reaction is different. I almost left a response after reading Mike’s post, but I thought I would write about it here instead.

This is a case where pre-bolusing didn’t work for me.

Friday morning, I was in a hurry to get to work, and I ran out the door without preparing my lunch. This isn’t something I do very often; only about 8 or 10 times per year, I’d guess. Anyway, to save time, I ran out the door with the expectation that I would just grab lunch at a local deli near where I work downtown.

So lunchtime comes, and my BG reading says 82 mg/dL. Not too bad, right? I know I’m buying out for lunch, and that usually comes with more carbs than my normal lunch. Hence the pre-bolus. I knew what I was going to order, and I bloused for it as I was headed downstairs.

I got downstairs and walked the two blocks to the deli, ordered a grilled ham and cheese and a bag of chips to go (this is why I don’t eat out for lunch often). I got my order and started walking with it back to the building where I work. So far, so good.

But when I got back to work, the fire alarms were sounding and I was told I couldn’t go back into the building.

Now I start to worry. I’m worried because I know hypoglycemia is either here or close. And immediately, I started to form contingency plans in my head:

– What if I can’t get back into the building in the next few minutes?

– What if I’m expected to walk down the street and gather with my co-workers at our assigned evacuation spot?

– What will my co-workers think of me if I start gobbling down my lunch in front of a potentially serious gathering of hundreds?

– What if my glucose gets too low before I can figure all this out?

– What if it’s some other kind of emergency and my co-workers are stuck inside while I’m stuck outside? Now I’m concerned about them. How can I help?

To answer these questions, my mind started racing through all kinds of potential scenarios. Sometimes when I’m low, this type of thing races through my head like wildfire in a pine forest. My mind knows that I’m supposed to eat, eat, eat. But that part of my instinct was trying to be squashed by something that almost borders on paranoia.

After a couple of minutes of waiting, but what really seemed like half an hour or so, the alarms were turned off and I was able to get back into the building and enjoy my lunch. A weird middle of the day, for sure.

What does this episode tell me? It tells me that I need to do a little self-examination, and see if I can come up with ways to trigger my brain to eat in those circumstances rather than worry about anything else. For me, I know that hypoglycemia sometimes impairs my judgement. But if I can focus on something, anything that helps me remember what I have to do even while mind games are going on inside my head, I’ll be all right.

In the meantime, you better believe I packed my lunch today.
 
 
 

By StephenS | Posted in Lows | Also tagged , | Comments (2)

On the glucagon trail.

June 11, 2013 – 9:44 am

We spend a lot of time around here talking about diabetes and keeping our blood glucose levels from getting too high. But we haven’t spent any time, really, talking about the treatment for seriously low blood glucose levels. I’m talking about glucagon.

Today, glucagon as an emergency medication carries the same set of instructions that it has for a long time: A nine step set of procedures (according to Eli Lilly & Co.) that involves using a syringe to inject an inactive ingredient into glucagon, mixing it, and drawing it back into the syringe and injecting it into the hypoglycemic patient.

I guess that sounds a little antiquated, plus a little time-consuming at a time when every second counts. But what can be done about that? Is there anyone out there working on streamlining glucagon delivery?

I met a couple of people back in March who are with a company that is working hard on new ways to make glucagon simpler and easier for anyone who may need it to treat hypoglycemia. Austin, Texas based Xeris Pharmaceuticals is on the front lines in a niche part of the market, working on a couple of projects and getting funding from the National Institutes of Health.

One of those projects is something called the Glucagon Pen (or G-Pen™). Also, they’ve received additional funding recently via a Phase II installment of a Small Business Innovation Research (SBIR) Fast Track grant to advance the company’s room-temperature stable, non-aqueous glucagon formulation for the advancement of a bi-hormonal pump artificial pancreas. You heard that right. Bi-hormonal. Insulin and Glucagon. The total of the grant funding amounts to $1.05 million.

Today I’ll be sharing a brief interview with a company representative, and information on some of their competitors.

I had a chance to ask a few questions of Saretta Ramdial, Manager of Corporate Affairs at Xeris. I had a few more questions besides these, but they are on hold for now. Some things can’t be revealed while research continues.

Stephen: I met part of your company’s team back in March at the Capitol-area JDRF conference. Are you going to a lot of these? Are they all patient-related functions, or are there conferences, etc. featuring healthcare professionals that you’re also going to?

Saretta Ramdial: We attend a number of different types of conferences that range from scientific and technology-focused to patient-advocacy focused events. This year, we’ve participated in the JDRF Type 1 Now conference in Austin, TX (our second year in attendance) and the JDRF Research Summit in Bethesda, MD (where we met you!). We plan to attend the ADA’s Scientific Sessions Conference as well (we had both of our abstracts accepted this year). We also attended the Taking Control of Your Diabetes conference in December 2012 which was held in Austin, TX.

Stephen: Tell me about how Xeris is revolutionizing the idea of glucagon delivery. I understand this includes glucagon that doesn’t require mixing, and can be delivered via a pen?

Saretta Ramdial: Our lead product in development is the Glucagon Pen or G-Pen™ which utilizes our proprietary, room-temperature stable, liquid formulation of glucagon, a rescue drug for hypoglycemia. The current standard of care is a nine-step process which can seem arduous in an emergency rescue situation where the caregiver must assemble and administer an intramuscular injection. From the patient perspective, Xeris’ solution would be more straightforward than and just as effective as the current glucagon kit because of its patient-friendly approach and ease-of-use. The G-Pen™, similar to an EpiPen™, would be a pre-loaded ready-to-use auto-injector device that would cut the administration of glucagon down from nine steps to two (uncapping and pressing the pen against the skin).

The G-Pen™ technology will be applied to a mini-dose glucagon pen (G-Pen Mini™) which can be used for smaller zero-calorie dosing applications for mild to moderate hypoglycemia. This is especially important for people with weight management concerns when it comes to managing the sometimes unpredictable rollercoaster of blood sugar levels.

Stephen: Are you receiving any funding from sources like JDRF, ADA, or other diabetes organizations?

Saretta Ramdial: We receive funding from a number of sources including the National Institutes of Health (NIH), The Helmsley Charitable Trust, and The Emerging Technology Fund through the State of Texas Governor’s Office.

Stephen: Do you have any competition in this space right now? (I’ll be looking this up anyway, but I thought I would ask).

I actually didn’t get an answer to the question, but I was provided with the link to a Closer Look memorandum, from Kelly Close’s Close Concerns. It’s available via the Xeris website:
http://xerispharma.com/2012_06_08_CC_Xeris_Glucagon.pdf

The memo is a detailed five page research sheet that goes into great detail about who is working on glucagon solutions (no pun intented). According to the memo (dated June 8, 2012– used with permission), the Xeris glucagon pen is being designed to be stored at room temperature, with a two year shelf life. So… a G-Pen™ with simple steps, that doesn’t need to be refrigerated. And, the work with organizations that are going to clinical trials very soon with an insulin/glucagon bi-hormonal pump for the Artificial Pancreas.

I looked online for information about the competitors working in this space that were mentioned in the memo. I couldn’t find much online, so the following is partly from the memo and partly from what I found online.

The Competitors:

– Arecor: The biggest development I’ve been able to find lately is their collaboration with Eli Lilly to develop the same type of glucagon formulation that Xeris is working on.

– Biodel: Again, working on a stable glucagon that will be viable for two years at room temperature. Last September, Biodel was awarded a National Institutes of Health (NIH) grant to develop glucagon for a bi-hormonal AP pump. Last December, the FDA granted orphan drug designation to Biodel’s product. The FDA grants orphan drug designation to help promote development of therapies to treat rare diseases (don’t know how rare diabetes is these days). They may also be eligible for FDA grant funding, certain tax credits, and a seven year grant of exclusivity to their drug should it gain FDA approval. Just last Thursday, Biodel announced plans to apply to the FDA for an Investigational New Drug Application sometime in the next twelve months. If that’s OK’d, they’ll go into clinical trials by the second half of next year, with an eye toward applying for an official New Drug Application with FDA sometime in 2015. In addition to the glucagon, this application should include the injection device too.

– Enject: Speaking of injection devices, Enject has a nice demonstration of their pen on their website. And, that’s about all I could find. The Closer Look memo talked about a delivery system that would reduce the steps needed to inject glucagon down to just three, and mentioned that they anticipate filing a New Drug Application with the FDA by the end of this year.

– Latitude: In April of 2012, Latitude announced that they had developed the first stable glucagon formulation that was ready to inject. They call it Nano-G. Back then, they were actively seeking well-heeled partners to help them bring their idea to testing, FDA approval, and then to the market.

There was one other firm noted in the memo: PhySci. Formerly known as Marcadia, PhySci was acquired by Roche. Since then, not much to report, and I couldn’t find anything on the web about PhySci or Roche glucagon improvements.

In looking into all this, I found out some things, but not nearly enough. I’ve seen a lot, but I haven’t yet seen the actual thing that everyone is shooting for. Truth: Maureen finds the current delivery of glucagon too scary to ever attempt using it. The idea that glucagon can be stabilized and put into a simple pen so any caregiver can administer is an idea who’s time has more than come.

I’ll be watching, and hoping, that glucagon delivery can become as commonplace as just about any other type of injection. I’m rooting for Xeris, and any other outfit who can make this a reality.
 
 
 

By StephenS | Posted in Diabetes | Also tagged , | Comments (3)

Highs vs. Lows.

May 23, 2013 – 9:30 am

Seems to me there’s a disparity in dealing with high glucose versus dealing with low glucose. Okay, maybe it’s not as serious as a disparity, but I’m trying to keep this light here, okay?

When my BG is low, I find that there are many things that I can use (read: ingest) to get myself back into a safe range. Among them:
 
 
– Juice

– Glucolifts (Cherry… yum)

– Honey

– Goetze’s Caramel Creams (addictive)

– Fruit

– Level Life Glucose Gel (kinda like the Mandarin Orange)

– Smarties (which are Rockets north of the border)

– Rockets (which are Smarties here in the USA)

– Insert your favorite here (Nutella, Maple Syrup, etc.)

– And, as a last resort, Glucagon
 
 
That’s at least nine items that I can use to bring up my glucose from an unsafe level. Having low BG is no picnic, of course. But those options almost feel like a reward for suffering through hypoglycemia. Almost. But not quite.

But what if my glucose is high? What if my pump has an issue delivering insulin, or it’s a hot day and the insulin loses its effectiveness, or I under-bolus for lunch? Now, I’m hovering near 300 mg/dL and I only have three options available to combat the high BG:
 
 
– Insulin

– Drink lots of water

– Exercise (while drinking lots of water)
 
 
That’s not a lot of options. And they’re not very appealing either. Also, if you have Type 2, you may not be on insulin therapy, so you may be left with only two options. Woo-freakin’-hoo.

In a way, having fewer choices when you’re high takes a lot of the guesswork out of what you need to do. You’ve just gotta do it, right? Using one, or two, or three methods. And it’s likely that you’ll have to wait to get yourself back into range. I mean, when you’re low you drink some juice, pop some glucose-laden product, and you’re often back in range within minutes. When you’re high, you can give a correction bolus of insulin, drink lots of water, and go for a run, and you’ll still have to wait some time before your BG comes back down.

I think this disparity in available options and time needed to correct explain why I absolutely hate being high, and why I try to do everything I can to avoid it. That doesn’t mean that I’m doing everything I can to be low. It just means that I don’t worry about being low as much as I worry about being high, if you know what I mean. Plus, I’ve got to admit, I hate how it makes me feel.

I suppose I could use this discussion to push for development and approval of faster-acting insulin. But I’m not thinking about that right now. I’m thinking about how high BG makes me feel, physically and mentally. And how that’s completely different from how I feel about low BG.

What about you? Do you worry more about high BG than low BG? Do you still worry about low BG, but secretly like the fact that it allows you some seemingly guilt-free indulgence? I’d love to hear what you think about both ends of the glucose spectrum.
 
 
 

By StephenS | Posted in Random Glucose | Also tagged , , , | Comments (11)

Post-mortem on Monday morning’s low.

April 24, 2013 – 11:00 am

I really wrestled with whether I should write again about my severe low early Monday morning. In the end, I’m writing this wrap-up because when something like this occurs, it’s important that I (and The Great Spousal Unit) examine what happened, and if I can, do something about it. Only then can I move on.

So here are some bullet points on Monday morning’s hypo event:
 
 
– First of all, many thank yous to everyone who left a comment here or on Facebook. I appreciate the fact that you were so concerned for my well being. Even when I’m making stupid mistakes. Read on…

– Looking back at my pump, I saw the most obvious problem… I bolused twice for dinner. Once before dinner (which I forgot about), and about an hour later. I remember thinking that I hadn’t bolused, and like an idiot, I didn’t check my pump and bolused again. Plus, my glucose was really climbing at that point, and I was very concerned after being high in the afternoon. On top of that, I bolused for a snack about an hour and a half after dinner. So yeah, I seriously stacked my boluses. I won’t ever bolus again without double-checking the pump first. I’m feeling really, really stupid about this. Really, there’s just no excuse.

– I was fighting really high BGs all day Sunday (in the 300s), with the breaks from that only coming just before meals. The morning spike was probably due to a high carb breakfast. I had a low carb lunch, but later found tubing that was clamped off by my pump’s belt clip. I changed the tubing, and worked on fighting the highs off the rest of the day. I was sinking pretty good before dinner, then had another large post-prandial spike an hour later. When I went to bed, I was still at something like 218 mg/dL, but I really had way too much insulin on board at that point.

– I slept through all of the Dexcom alarms. Or, I slept through turning them off. I don’t know. I do know I remember one alarm early on (probably around 1:00) that I heard. I turned it off, ate a few Glucolift tabs, and went back to sleep (I know, I didn’t check the BG). I don’t recall hearing another alarm. Maureen sleeps next to me, and she doesn’t recall hearing an alarm either. But she was sleeping as soundly as I was.

– Speaking of the Dexcom… I’m getting some very useful data on how my glucose trends through the day. That’s the good news. The bad news is that I’m obsessing over it too much. I don’t want to say I’m treating solely based on what I’m seeing on the receiver’s display. I’m not sure I’m ready to be honest with myself about that. But Maureen mentioned just today that I “need to stop paying so much attention to that thing”.

– I have a nice bruise on the side of my head, and a cut on my ear. Probably from falling out of bed, but I really don’t know. I guess I should be happy that’s all the physical reminders I have from this.
 
 
The final analysis: It was an epic fail on my part. I cowboyed my way through the day instead of being patient.

Many times, I’ve commented on blogs and told people in person that you can’t worry about the past. It’s only a reference point. What counts is making the most out of today and tomorrow.

Now I have to go practice what I’ve been preaching.
 
 
 

By StephenS | Posted in Lows | Also tagged , | Comments (3)