There’s more to T1D hormones than insulin.  Yet most of us treat our type 1 almost exclusively with insulin.

The interplay of the hormones made in the pancreas is complex stuff.  Here’s an attempt to explain the main players simply:

• INSULIN is a “key” that “unlocks” cells so the glucose (the sugar we get from food) can move from the blood stream into the cells.
• GLUCAGON can be thought of as the “opposite” of insulin (the insulin antidote); glucagon is another “key” that unlocks glycogen (stored glucose) from the liver when the body needs glucose but doesn’t have enough in the blood stream.
• AMYLIN is another “key” that partners with insulin to help modify the rate at which glucose is metabolized.

Though all three are important, most of us leave the hospital with the mindset that INSULIN is our mainstay: something we use daily and are tempted to stockpile and tends to feel like very precious stuff, because it is precious stuff indeed.  The fact is, we cannot survive without insulin.

We think of GLUCAGON–in its bright red official-looking case with its component parts and step-by-step instructions–as the pulp-fictiony very scary stuff you must have on hand, but that you really hope never to use.

I am beginning to wonder if this thinking should change some.

I began thinking this one August evening when fourteen-year-old Will was suffering a gnarly bout of heat stroke he’d developed after a weekend-long soccer tournament.  Will was feverish and headachy and seriously nauseated.  Oh, and, of course, low.  With a blood glucose reading of 62, he needed to eat or drink something but refused, saying “I’ll puke!”  Needless to say, this was stressful.

Finally, with some cajoling and a couple outright threats, Will managed sips of lemonade.  Between them he kept saying, “We’ve got to get mini-glucagons!  We’ve got to get mini-glucagons!”

Will knew about “mini-glucagons” from his beloved Bearskin Meadow Camp, where counselors administered small doses of glucagon at midnight to campers who went low.

This made good sense to me when Will described it, and the approach has had good documented success, but the use of the stuff that I had only seen in its scary red powder-liquid-syringe kit sounded like it was for experts only.

After the heat stroke, though, I promptly contacted our endo wanting to get a prescription for the magic stuff.

“Oh, there’s no presciption.  You just use the glucagon you have.  One unit per year of the child’s age.”

Simple as that!

Of course, we have yet to use it.  When Will–who is very athletic and growing about an inch a month–is low, he’s always happy to eat an Air Head or Smarties or Glucotabs or Skittles or . . .  Call him crazy, but he’d rather eat candy than stick another needle into his body.

There are, though, many occasions in the future when I can see a quick glucagon injection being a solid idea:

• If he’s really nauseated,
• If he’s in the middle of such intense sports that a mouth full of sugar sounds gross,
• If he is NOT doing such intense sports anymore because he’s twenty-six and busy curing cancer or teaching kindergarten or some other noble pursuit and just isn’t wild about the idea of all those empty calories because even though his smart and intelligent and supportive girlfriend won’t care that he’s lost his washboard abs, it’s not healthy to be overweight.

One drawback is that once you mix your glucagon, the vial of it won’t last as long as insulin (which lasts 28 days once opened).

I have read that glucagon, once mixed, will last up to 48 hours in the refrigerator.  (Although a very smart, diabetes expert MD PhD did tell me that it would probably last a month.)

As you all know, I’m no doctor.  So do talk to your T1D team before you dive in to this kind of therapy.

But when you are faced with a stubborn low and a person who doesn’t want that fourth giant, chalky Glucotab, this just might be a tool you’ll be happy to have in your belt.