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Mini-Glucagon dose for nighttime hypoglycemia--I tried it!

Discussion in 'Parents of Children with Type 1' started by Twinklet, Aug 2, 2008.

  1. Twinklet

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    At camp this year, they were doing a study with mini-doses of Glucagon for BG lower than 60. I never tried it because I thought it was overkill, but then they had a lecture with the results from kid's camp. Apparently using it brings low BG up nicely without the rebound highs that typically happen when kids require a lot of carbs for a low.

    So yesterday we were at a music festival all day and ate tons of different foods we're not used to. So we had to guess on a lot of carbs. Everything was fine till we got home and Emily fell asleep. Her sensor began to alarm at midnight and she was in a vertical nosedive from 120 to 60. I checked her BG and it was 54. She had 4 units IOB over 4 hours, plus a combo/dual-wave going. Ugh. She was also sound asleep and I know her stomach was full from sampling all the foods we ate.

    I knew we'd need a lot of carbs to stop the drop from previous experience. So instead I got out the Glucagon and injected 10 units.

    I sat back and watched the Navigator drop 2-3 points each minute and felt a little panicky. But I decided to gut it out for 10 minutes before giving any carbs.

    At the 7 minute point, the straight-down arrow switched to an angled arrow down. At the 9 minute point, the arrow straightened out and her BG was up to 61 from 46.

    At the 15 minute point, her BG was 87 and steady arrow!

    I waited another 15 minutes, no change. 87 and steady arrow (Fingerstick 91)! I gave her 2 tabs at that point and went to bed.

    She did go up to 195 about 3 hours later, but I think it was from funnel cakes and other junk. Even if it was from the Glucagon, that is MUCH better than the 300 rebound we'd be fighting otherwise!

    Here's the kicker: This morning I went to toss the Glucagon package. I had grabbed the wrong one! What I gave her expired in SEPTEMBER 2007!!! :eek: I had it set aside to practice with but grabbed it in the dark. We've been told repeatedly at camp to try the expired Glucagons for mini-doses (NOT for emergency use) because in their experience it still works. Well--I guess they were right!
     
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  2. frizzyrazzy

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    fabulous info Andie! Awesome!
    and I love that the expired gluc worked too. I've got that coming out my ears LOL.
     
  3. saxmaniac

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    Did you cancel the extended bolus? That make sense, if you have a full stomach that's just not processing fast enough, eating some glucose can be blocked by whatever is there. But the mini-glucagon can bypass that directly. 10 units sounds like a lot, how did you arrive at that number?
     
  4. frizzyrazzy

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    I'm not andi but the usual mini-dosing is always 1unit for each age. :)
     
  5. Twinklet

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    Sax, I did cancel the extended bolus but probably shouldn't have. I was just scared, I guess-the line on the CGMS was almost vertical. That may also be why she spiked up 3 hours later.

    They told us 1 unit per age for the Glucagon, that's how I got 10 units.

    One more thing: The Pedi Endo at camp (who also has Type 1) said she has carried around mixed Glucagon in her purse for a month and used it for lows (she likes to experiment on herself--LOL!) and it continued to work for that period of time.

    So I'm going to keep my expired Glucagons now for nighttime lows like this. Emily didn't even wake up and getting her to drink a ton of juice at that time would have been really hard.
     
  6. saxmaniac

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    Ah, I keep forgetting this. Alex's rx is 0.5mg which is 5u, right?
     
  7. katie.c

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    When you mix it all up I'm pretty sure the whole vial has 1mg of glucagon, so you would fill the syringe that comes with the kit half way, but I think that would be for emergencies. At least that's what we would give our 5 year old for emergencies. I might be wrong though, it's happend before. There's 1ml of diluting solution that comes in the syringe, and half is .5ml or 50 units. I think if you were to use a regular syringe instead, because that needle is kind of scary, you would pull up 50 units to get .5mg. For the mini-dose 5 units would make sense if it's 1 unit for every year though.
     
    Last edited: Aug 2, 2008
  8. Rick

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    I'm pretty sure 0.5mg = 0.5 u of Glucagon.
     
    Last edited: Aug 2, 2008
  9. frizzyrazzy

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    correct. The emergency dose is usually a ton more than a mini-dose.

    if I'm remembering correctly isn't glucagon is 1mg / ml so on a 100u syringe would that actually be 50u? Because mg cant' be directly converted to units so you have to know how many ml are in that mg and in this case it's 1 to 1. and if a ml is the same as 1cc that would be 100u on one of our insulin syringes. right?

    maybe I'm messing up my math....
     
  10. katie.c

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    Well if you're messing your math up I am too because I got the same answer.

    The vial has 1mg. The syringe has 1ml diluting solution. 1ml=100 units. 1ml glucagon should have 1mg. if 1ml is 100 units and has 1mg, then 50 units would have .5mg. Right? I'm confusing myself now.
     
  11. frizzyrazzy

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    LOL..I know. I'm confusing myself too.
     
  12. Budapest

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    As far as the math goes: 1ml (1mg) = 100 U. (the beauty of the metric system) :)
     
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  13. frizzyrazzy

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    so then we are correct? is that what you're saying LOL. if dosing for rescue glucagon says .5mg and we know that glucagon has 1mg per ml then if we were to dose glucagon with a regular insulin syringe we'd by using 50units?

    right?
     
  14. moco89

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    Wait, the whole glucagon dose reconstituted (liquid mixed with the actual powder) would not equal 100 U because the volume of the solution is dependent on the the molecular weight of the solute (the powder part of the glucagon).

    In order to figure this out, you have to find out the mass composition of both the solvent (the dilution stuff in the syringe) and the solute (powder stuff in the vial). Then, we could find out the volume of the solution. Then we could convert it off to "insulin units".

    BTW, on all insulin bottles, it says one mL=100 units. therefore 1mL of the glucagon solution will equal 100 units of glucagon on an insulin syringe.
    BUT, if you do the math 1 mL (volume) + the mass (1 mg) cannot equal 1 mL/100 insulin units

    Although you cannot add mass and volume (unless using molecular weight conversions) together to find out the volume of reconstituted glucagon (to calculate the "insulin units" conversion), this proves that there is > 100 insulin units in reconstituted glucagon. The volume of the powdered portion of the glucagon is not accounted for through these previous estimates. Therefore, the volume has to be greater than 100 "insulin units" or "one mL"
     
    Last edited: Aug 2, 2008
  15. Rick

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    Yes you would have very close to the correct dose (0.5mg) of glucagon for someone less than 20 kg, but my understanding is that for “rescue“ use it should be injected into the muscle for a faster response. So I would think it would be best to use the syringe supplied in the kit.
    It’s important to note that 1ml is not the same as 1mg and that 1ml only equals 100u if the CONCENTRATION of the medicine you are using is 100u, 1ml of 500u Humalog equals 500 units. 1ml of glucagon as supplied in the Lilly kit equals 1 unit of glucagon according to their product information.
     
  16. moco89

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    1 mg is a mass (weight) measurement, 1 mL is a volume (displacement) measurement. They cannot be converted in to a single volume measurement, with the information supplied on the glucagon box.

    Even if the powder was in volume form before the reconstitution (mixing), it would not necessarily mean that the volume would be the same when both the liquid and powder are mixed together. Some solvents are polar, which alters volume when the two substances are mixed toghether.
     
    Last edited: Aug 2, 2008
  17. moco89

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    All insulin in the US is 100u, except for one exception-for the extremely insulin resistant. Eli Lilly makes a 500u regular, and that is the only exception the FDA makes for the 100u measurement in the US.
     
  18. Budapest

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    I stand corrected. :p

    The volume of 1U (same as 1 IU) of various substances is not the same. From wikipedia:
    Indeed according to the packaging of the glucagon 1ml = 1U. However if you want to use a (standard, 100U) insulin syringe, you would need to pull back the plunger until 50 U to administer 0.5mg or 0.5 U of glucagon.

    As Rick also pointed out, in an emergency situation glucagon should be administered into a muscle that requires a much longer needle than normally used for insulin.
     
  19. frizzyrazzy

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    very correct. which is why it's so confusing because we're talking about two things which can't work together mg and ml and glucagon in an u100 syringe.

    very true. I think we only got on this discussion because it was suggested that the rescue dose is only 5u for a small child but it's not. It can't be.

    right.

    It is confusing which is why we should be using the syringe provided for rescue *unless you want to take the time to figure it out by mixing up expired glucagon, and then testing to see how much the proper dose comes up on a regular syringe and yes, it works much much quicker if it gets into a muscle.
     

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