Contributor: Dr. Staci-Marie Norman, PharmD, DCES

Hypoglycemia, or low blood glucose, is common in diabetes management. If your medications include insulin or sulfonylureas, then you are at risk of hypoglycemia and should have a plan in place for treatment.

The first step to managing hypoglycemia is knowing the Rule of 15. Start by checking your blood glucose meter or continuous glucose monitor (CGM). If your reading is 70 or less, or you have trending arrows indicating rapid blood glucose decline, treat with 15 grams of fast-acting carbohydrates. Examples include:

• 3-4 glucose tablets
• 4 oz fruit juice
• 6 oz cola (the real thing, not diet or zero)
• 15 Skittles
• 5 Life Savers candies
• 1 tube cake gel icing

Wait 15 minutes and recheck your blood glucose or CGM trending arrows. If your blood glucose is above 70mg/dL and rising, eat a snack that includes protein and fat. (Or, if it is time for a meal, skip the snack and have your meal.) If your blood sugar is not above 70mg/dL or trending up, treat again with another 15 grams of fast-acting carbs and check your number after another 15 minutes.

Sometimes your blood glucose can get so low that treating with 15 grams of carbohydrates won't have a timely enough result. Glucagon might be the more appropriate treatment for severe hypoglycemic events (less than 54 mg/dL), especially if you are not coherent enough to treat yourself. Some types of glucagon kits have been available for many years and need to be mixed and injected by a caretaker or loved one. It can be difficult, even for someone trained to do this, because you are in an emergency situation that (hopefully) doesn't occur often.

Two newer glucagon administration devices have been developed in the past few years and are currently on the market. These new preparations are stored at room temperature. Manufacturer coupon cards may be available on their websites to lower your copay (depending on your insurance plan).

• Gvoke HypoPen is a pen prefilled with glucagon that is already mixed and is stable for thirty months after manufacturing. It is easy to administer - pull off the red cap, push the yellow end down on the skin of the upper arm, stomach or thigh, and hold for five seconds until the window turns red. You can even view a video demonstration here. (View a video demonstration in Spanish here.)
• Baqsimi is nasal glucagon in a dry powder form. It comes as a single-dose spray that is administered into the nose. You can see a demonstration video here.

I hope you never have to deal with severe hypoglycemia, but it is wonderful to know we have products that are easy to use and effective for such situations.

Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.