Need help navigating life with diabetes? Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil's tackling a question about hypoglycemia and how glucagon can and should be used in those situations. And he some lifeboat analogies to go along with that! So, read on...

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Angel, type 1 from New York, asks: If someone is having a seizure, what's the longest they could feasibly go without glucagon? I've seen a lot of people, especially mothers of type 1 kids, talking about this on message boards recently, and it got me wondering. My parents never kept an active glucagon kit in the house when I was growing up. Dad's theory was that 911 would get there just as fast as him remembering how to do a glucagon shot while panicking over me having a seizure. Is that actually a mindset people should have? What is the risk that a child is going to totally have permanent brain damage or die?

Wil@Ask D'Mine answers: How long do you have between lights-out and cellular brain damage? Seconds. The brain is the biggest frickin' sugar hog in your body. Fully 20% of the calories you consume in a day go to running your brain. Brains don't like to be without sugar and do very poorly when deprived. That's why people experiencing glucose lows act drunk. The brain can't function without sugar.

In fact, brain cells are most likely dying when you are very low, even before you pass out. In the absence of sugar, the little suckers starve to death very quickly. But don't freak out. Even a deep drag on a cigarette kills a brain cell or two, but you can smoke for years and years without brain "damage." After all, your brain has 100 billion cells. Losing a few won't make much of a difference.

But actually going fully lights-out is different. More extreme. Most researchers believe that any seizure results in at least some degree of brain damage; and the longer you are unconsciousness, the higher the degree of that damage. How long does it take to "totally have" permanent brain damage? One minute? Five minutes? Thirty? An hour? Who the f*** knows? Because it depends. It depends on how fast and how deep the hypo went, how much insulin is on board, the individual's ability (or inability) to get the pancreas to signal the liver to cut loose with some emergency sugar, what the barometric pressure is, whether the wind is blowing from the west or northwest, what phase the moon is in, and whether or not Mars is in Sagittarius.

In short, no two PWDs are the same. And no two critical hypos in the same PWD will ever be the same either.

Speaking of the wind and the moon—a calm, moonlessnight in April of 1912 holds a lesson for us all. That was the day a big ship bonked into a small chunk of ice in the middle of lonely stretch of ocean. This incident could have been nothing more than a forgotten footnote in nautical history if it were not for one tiny little fact that made a simple bad day go terribly, terribly wrong. The ship, called Titanic, carried 20 lifeboats that could hold a maximum of 1,178 people. The problem was that the ship had 2,223 passengers and crew on board. Oh. And it bonked the chunk of ice in a bad enough way that the ship sank.

Where am I going with this? I'm just suggesting that you shouldn't book a trip on a big ship that's traveling through bone-chilling waters without enough lifeboats. Because, really, what are the odds your ship will bonk into a chunk of ice and sink? Not very great. Thousands of ships have traveled that part of the ocean with no trouble. But that doesn't make lifeboats a bad idea. Lifeboats are a very, very good idea because ships are made of metal, and metal is heavier than water, and every now and again they do sink. And when ships sink, lifeboats save lives.

Now, what are the odds you'll have a hypo bad enough to sink your brain? Again, not very great, but every now and again it happens to people. A glucagon emergency kit is your lifeboat. And I have very, very, very, very strong feelings about them.

I'm sorry, Angel, but I disagree with your Dad. I don't think that's the mindset people should have. I think every parent of a child with diabetes should be equipped with a kit and know how to use it. Beyond that, I feel every adult type 1 should be equipped with a kit, and every loved one of a type 1 adult should be trained to use it. You shouldn't be allowed to kiss a type 1 until you demonstrate competency with a glucagon kit.

When my son was only 5 years old I taught him where to find mine (one in my night stand and one in my Go-Bag), and how to use it. He's been itching to use it ever since.

Sticking with our water, sinking, and death by drowning theme, let's make it simpler: If your loved one couldn't swim and fell in the water at a pool-side barbeque, would you toss them a life preserver or wait for the professional lifeguard to take care of it?

(I can't believe we are even discussing this.)

Look, even if the paramedics are pounding up the stairs, give the damn shot! When you are lights-out from a hypo brain cells are dying. We don't know how many or how fast, but the shit has really hit the fan. Moments count.

Speaking of moments, how long does it take to give glucagon properly? A glucagon kit isn't an EpiPen. Not yet. There are steps you have to take. It takes time to do it right. Maybe as much as a whole sixty seconds. If you dilly-dally. So you have to live pretty close to the ambulance base for the paramedics to be there in under a minute. It doesn't take much training to learn how to do it. Even school personnel nationwide are trained to use them.

Will your loved ones panic like your Dad worried he would? Sure. Maybe. It happens. I personally know one case where a mother panicked and injected her young adult type 1 son with the sterile water (she didn't mix the powder first). The outcome? He died. Sorry. No happy ending. No joke. No wise-ass crack. And he's not the only one. Make no mistake, hypos do kill type 1s. I hear between 3,000 and 9,000 of us on any given year, depending on the year.

Diabetes is dangerous business and hypos are not to be trifled with. But who knows how many type 1s are alive and well today because their loved ones used the kit right?

Yes. Maybe professional help will arrive in time to avoid brain damage or death. But even if it does arrive in time, what's the harm in giving the rescue a head start? That's why we train everyone we can get our paws on how to do CPR, right? If someone stopped breathing, and you know CPR, would you sit back and wait for the paramedics? I hope to God not.

Back to panic for a moment. In times of stress, people tend to resort to their training. So train. Do glucagon fire drills. Check out Lilly's new mobile app that's a teaching tool for using glucagon. It's fun.

The injectee gets to simulate a bad low, complete with directing foul language at their loved ones, staggering in circles, then collapsing dramatically onto the floor. The injectors then practice the ritual, without the final injection, of course. And hey, when your kit expires, about once a year on average, take the fire drill to the next level with an injection into a piece of past-due fruit.

Here's hoping your ship never bumps into a chuck of ice on a moonless night. But if it does, isn't it better to know where your lifeboat is, and how to properly launch it?



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.