FOR EMERGENCY LOW BLOOD SUGAR:

- [(https://gvokeglucagon.com)

- [Xeris Gvoke HypoPen® Instructional Video](https://youtu.be)

WHAT DO YOU DO IN CASE OF EMERGENCY?

In case of an emergency, there are few things to do. If we are ever passed out or unconscious, immediately call emergency services and react to the situation as if we were “having a low” or experiencing severe hypoglycemia. If we are unconscious, you may have to administer emergency glucagon, either nasal glucagon BAQSIMI or with injectable glucagon via a Glucagon kit. If we are conscious, fast-acting glucose needs to be taken immediately. This means juice boxes, candy, glucose tablets, or any other sugary food or drink that can be consumed easily.

“Having a low” or experiencing severe hypoglycemia is dangerous and action must be taken immediately.

• If we are unconscious, call emergency services and you may have to administer emergency glucagon (either nasal glucagon BAQSIMI or injectable glucagon.)
• If we are conscious, fast-acting glucose needs to be taken immediately. This means juice boxes, candy, glucose tablets, or any other sugary food or drink that can be consumed easily.

Type 1 diabetes is an autoimmune disease that affects a person’s pancreas. The pancreas is responsible for producing insulin, a hormone people need to get energy from food. Our pancreas, for reasons that have not been identified, does not produce any insulin. As a result, we need to inject or continually infuse insulin through a pump and carefully balance our insulin doses with eating and daily activities. We must also regularly monitor our blood-sugar levels. Type 1 is a non-stop and 24/7 balancing act that we must maneuver every day. There is no way to prevent type 1 and there is no cure (currently!).

We get by with a little help from our friends! These include our blood glucose meter, insulin, needles and monitors. The glucose meter is a device that measures blood sugar. We use a device that pricks our finger and we put the blood sample onto a test strip. From there, the test strip is read by the meter and gives us a number on the meter screen.

We can get insulin into our bodies through multiple daily injections or an insulin pump.

Injections are delivered to our bodies through insulin pens and needles. There are two types of insulin that we use:

1. Fast-acting insulin gives our bodies insulin right away and is taken with meals or to correct a high blood sugar. Fast-acting insulin is used multiple times a day, depending on when you eat.
2. The other is long-acting insulin, which is given once a day. Long-acting insulin is a slow release insulin that is given to your body in a span of 24 hours when needed.

An insulin pump is a device that is connected to the body, either through a tube or wirelessly. With the control of a device, you are constantly getting insulin through the pump. During meals, we can choose how much insulin to give, and the device is already in our skin and ready to deliver the amount needed.

Managing type 1 and exercise is a constant balancing act. When you add exercise into the equation of blood sugar and insulin, you have to take into consideration a few things. First off, the type of activity can affect blood sugar levels in different ways. Low intensity cardio, such as running, jogging, walking, biking, or swimming, can lower blood sugar levels. High intensity interval training can increase your blood sugar levels due to the amount of adrenaline and energy that your body is using. Nonetheless, each person’s body reacts differently. The only way to identify how your body will react to different exercises is to constantly be testing your blood sugar before, during and after physical activity to track trends and changes.

A fantastic resource for you is the Diabetic Athlete’s Handbook: Your Guide to Peak Performance by Sheri R. Colberg, Ph.D. This book has tons of sports, pump adjustments and mentions what carbohydrates are needed for different activities. A solid read of this book can give you a foundation to understanding the basics of diabetes management in different types of activity.

The day in the life of someone with type 1 involves frequent blood sugar testing and insulin treatment. Insulin treatment is not a cure for type 1; insulin is used to control our blood sugar. High or low blood-sugar levels can be common, even on a daily basis. The following indicators of low and blood sugar are general guidelines. It depends on the athlete and what is a typical range for him or her.

• High blood sugar (above 180mg/dL / 10mmol/L) 
• Low blood sugar ( < 70mg/dL / 4mmol/L ) 

High blood sugar (hyperglycemia) symptoms—

• Unquenchable thirst
• Dry mouth
• Fatigue
• Frequent urination
• Blurred vision

High blood sugar treatmentDepending on the age of your athlete, he or she will have training in a medical protocol to follow or specific instructions for care. Insulin or sometimes physical activity is used to lower blood sugar levels. Make sure to review the medical plan that the athlete has in place and know who is responsible for insulin administration.Low blood sugar (hypoglycemia) symptoms—

• anxious feeling
• behavior change similar to being drunk
• blurred vision
• cold sweats
• confusion
• cool pale skin
• difficulty in concentrating
• drowsiness
• excessive hunger
• fast heartbeat
• headache
• nausea
• nervousness
• nightmares
• restless sleep
• shakiness
• slurred speech
• unusual tiredness or weakness

Low blood sugar treatment—

Treat with sugar immediately (glucose tabs, fruits, fruit candy, Gatorade, or juice)

“Having a low” or experiencing severe hypoglycemia is dangerous and action must be taken immediately.

• If we are unconscious, call emergency services and you may have to administer emergency glucagon (either nasal glucagon BAQSIMI or injectable glucagon.)
• If we are conscious, fast-acting glucose needs to be taken immediately. This means juice boxes, candy, glucose tablets, or any other sugary food or drink that can be consumed easily.

The unpredictability of type 1 could affect your athlete’s performance on and off the field. Without calling your athlete out of a group, have a conversation about how they are going to control their blood sugar levels and keep track of how they are feeling beforehand. Allow them to take water breaks and quick opportunities to test blood sugar levels when needed. Have a solid understanding of the symptoms of hypoglycemia and hyperglycemia so that  you are aware if you need to intervene.

As a coach, you want to push each member of your team to his or her highest potential. Don’t see type 1 as a roadblock; see type 1 as a challenge that your athlete takes on everyday at practice!

In people with a fully functional pancreas, insulin and glucagon work in tandem to keep blood sugars stable. Insulin lowers blood sugar, while its partner, glucagon, releases the body’s glucose reserves from the liver to raise blood sugars.

If your resident is conscious but cannot consume sugar orally, she or he can administer the glucagon. If she or he is unconscious, you may need to inject the glucagon into muscle. Always contact emergency services when glucagon is used.

It is imperative that you are aware if your resident is sick. A typical cold, flu, or even hangover for someone with type 1 diabetes can be a life-threatening situation if not managed properly.

• If your resident is vomiting, you should contact emergency services.
• If your resident is “under the weather,” you can ask if they have checked their blood sugar recently and if they’ve tested for ketones.

Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in people with diabetes is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine.

Your resident should check for ketones anytime her or his blood sugar is above 240 mg/dL or any time she or he is sick. This includes any minor illness such as a cold.

Having ketones can indicate that your resident needs more insulin. If she or he have a build up of ketones, this can lead to diabetic ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea, vomiting, abdominal pain, fruit or acetone (think nail polish remover) breath, rapid breathing, flushed skin and lack of energy. If left untreated, it can lead to a serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body and if your resident is experiencing these, they should seek out medical attention.

WRITTEN BY: JULIA BLANCHETTE PHD(C), RN, CDE 2019-06-17

What are the differences between ketones, ketosis, and diabetic ketoacidosis (DKA)? These terms are commonly used in the type 1 community but what do they mean? Here is a breakdown of their definitions and differences.

Ketones are a source of energy for the cells in the body. Typically, glucose is used as fuel for cells. When the body is unable to access glucose for fuel, it uses fat stores as an alternative. The liver burns fatty acids and produces usable energy called ketones. There are three types of “ketone bodies”: acetoacetate, beta-hydroxybutyrate and acetone. Acetoacetate and beta-hydroxybutyrate transfer energy produced in the liver to the rest of the body. Acetone, also known as a “fruity breath smell” results from the breakdown of Acetoacetate.

Nutritional ketosis occurs when the body changes the way it gets energy over at least a few days. After the body burns through all of its glycogen stores, or cannot use glucose derived from carbohydrates for energy, it breaks down fat which produces ketones. In nutritional ketosis, small amounts of ketones are created and used as energy. The body will produce ketones until a more significant serving of carbohydrates is consumed. A diet that is high in fat, moderate in protein and extremely low in carbohydrates can result in nutritional ketosis. An extremely low carbohydrate diet consists of a 20-50g carbohydrate limit per day which varies based on body type and exercise.

Diabetic ketoacidosis or DKA is typically caused by a lack of insulin. Normally, insulin takes glucose out of the blood and allows cells to use glucose for energy. When insulin isn’t available, glucose remains in the blood causing hyperglycemia, and the body goes into starvation mode. Then, fat is burned as a source of energy resulting in ketone production. Very high levels of ketones lower the pH in the bloodstream leading to acidosis, or too much acid in the blood. These high levels of ketones are very dangerous and can be life-threatening.

Blood glucose  – also known as BG, blood glucose is the amount of glucose/ sugar in the blood.  Non-diabetics run around a steady 90 mg/dL.  People with type 1 diabetes try to stay above 70 and under a number determined by their doctor.

Check your BG/ Do a check/ Take a BG: to use a blood glucose meter and a lancing device to draw a drop of blood and test it for sugar content.  People with type 1 diabetes must do this regularly to see if their blood sugar is in range.

Hypoglycemia – also referred to as “hypo,” or “low,” hypoglycemia occurs when the body does not have enough sugar to function properly.  Your grandchild needs fast acting sugar.

Hyperglycemia – also referred to as “high,” hyperglycemia occurs when there is too much sugar in the blood.  Your grandchild needs insulin.

Glucagon – an emergency treatment that is either given nasally with BAQSIMI, or via a shot of a Glucagon kit. It is given to  people with type 1 diabetes (usually when they are so low that they cannot swallow) that provides “instant sugar” to the body.

Insulin – the hormone that our bodies make to turn food into energy. People with type1 diabetes don’t make insulin.  They must inject it to metabolize their food.

Carb count – (short for “carbohydrate count”) the number of carbohydrates in a given serving of food.  Knowing carb counts is essential; people with type 1 diabetes inject a certain amount of insulin for the all of carbs they eat.

Meter – A blood glucose meter (also known as a “glucometer”).  Meters are used to test blood and come with a lancing device to prick a finger.

CGM – CGM stands for continuous glucose monitor.  This device is attached to the body and monitors blood sugar on a 24 hour basis, and indicates trends.

Insulin Pump –This device is attached to the body and constantly delivers insulin to its wearer.

People with type 1 can eat anything that they choose to eat, as long as they correctly dose the amount of insulin needed for the food that is eaten. Although someone might assume that sticking to a strict no-carb diet would help us, there are MANY other things that affect our blood sugar. Everything in moderation!

There is a happy medium in between stocking your fridge with the healthiest foods and having all of the donuts, candy and chocolate available. For any person, eating healthy is the best way to feel better. However, it is important to not force any type of food choices to someone.

Be aware that our mood might be based on blood sugar levels, high or low. We may be very stubborn or crabby, or we may just need a juice box. Type 1 can be stressful at times, so bear with us! Here are the symptoms of highs and lows.

• High symptoms: nausea, deep sighing breaths, confusion, flushed and warm skin, drowsiness
• Low symptoms: shaky, pale and sweaty skin, headache, hunger, weakness, trembling

The day in the life of someone with type 1 involves frequent blood sugar testing and insulin treatment. Insulin treatment is not a cure for type 1; insulin is used to control our blood sugar. High or low blood-sugar levels can be common, even on a daily basis.

In case of an emergency, there are few things to do. If we are ever passed out or unconscious, immediately call emergency services and react to the situation as if we were “having a low” or experiencing severe hypoglycemia. If we are unconscious, you may have to administer emergency glucagon, either nasal glucagon BAQSIMI or with injectable glucagon via a Glucagon kit. If we are conscious, fast-acting glucose needs to be taken immediately. This means juice boxes, candy, glucose tablets, or any other sugary food or drink that can be consumed easily.

1. “Are you allowed to eat that?” Yes, we can eat anything as long as we correctly dosage our insulin.
2. To another person: “Don’t let (insert name) have any of that.” Steer clear of trying to micromanage our diets. We have a good understanding of what foods can do to our blood sugar.
3. Mixing up type 1 and type 2 – This is a very frustrating and common mistake that is easy to make for someone who isn’t familiar with diabetes. All of the jokes and movie references that you have seen about diabetes are most likely inaccurate and exaggerated.
4. “You shouldn’t be eating that dessert/pizza/pasta/sweet food.” Maybe you should trust that we are on top of it! We can enjoy these types of foods!
5. Sugar vs. Carbs – If a food doesn’t have any sugar, that doesn’t mean that it is a type 1’s dream food of choice. “Carb counting” is a term that type 1s go by when deciding how much insulin is needed for a meal. In other words, look at the carbs and sugar content of a food before saying anything!
6. “This is sugar-free, so you can have it!” “Sugar-free”, “low fat” and “low carb” are all labels that may seem ideal, but can be hidden with other triggers that can affect our blood sugar.
7. “But you are so healthy and active!”We didn’t get type 1 from our health choices! We got type 1 because our bodies physically cannot make insulin.
8. Any and all “I just ate so much dessert so I will get diabetes”jokes. They aren’t funny to us, and they also are not true.
9. “Do the injections hurt?” We are very tough people, and these injections are a daily part of our lives. We take care of our bodies and handle the injections with strength.
10. Trying to act as a doctor, nutritionist, counselor, or nurse.
    Everyone’s type 1 routine is individual. It is frustrating when other people try and tell us what we can and cannot do, or what we should do if we are feeling sick. The most important thing that a friend or family member can do is to be supportive and helpful without being pushy.