Ask D’Mine: Please Be My Diabetes Lifeguard

Ever wonder if you should tell people at your workplace about your diabetes? Especially when it comes to low blood sugars and what could happen if you aren’t able to treat a low yourself? Well, that’s the issue we tackle today in our weekly advice column, Ask D’Mine!

As per usual, veteran type 1, diabetes author and educator Wil Dubois has some tips.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Hannah, type 1 from New York, writes: I am 29 and was diagnosed with type 1 at age 12. My older brother was also a type 1 and died from a hypo when he was 16, just after I was diagnosed. Fortunately, I don’t have hypo-unawareness like he did, but as a young adult on her own I have been a bit careless about carrying a glucagon kit (I haven’t had one since my freshman year at university). My symptoms for hypos seem to be changing, though, and I know it’s the right thing to get a kit and train my roommates to use it. I’m debating with myself about getting one for the office and training a couple of my coworkers to test my sugar and use the kit. Part of me feels like this is awkward and unnecessary, and the other part feels I owe it to my mom, who already lost one child to type 1, to at least play it safe. Am I weird for even thinking of it? How do people generally deal with their D at work?

Wil@Ask D’Mine answers: Hannah, if you were going skydiving, would you accept the reserve chute? Or would you say, “No thank you. The main chute almost always works.”

Would you book a cruise on an “unsinkable” ship that didn’t have lifeboats? An Artic cruise?

Handle a pit viper without some anti-venom handy?

Diabetes is a dangerous business. As dangerous as parachuting over iceberg-infested waters with a pocket full of pit vipers and no lifeboat. OK… That metaphor really didn’t come together as well as I had hoped, but I guess I made my point. Of course you didn’t really need me to teach you that; sadly, your brother already taught you that lesson.

Stand by while I go light a blue candle for him…

OK, I’m back, and I have some pretty strong feelings about glucagon. Regardless of how intense your symptoms of low blood sugar might normally be, they can change over time, and no two hypos are created equal. And of course, even when we know we are low, sometimes reversing that situation is harder than at other times. Glucagon is our break-the-glass-in-case-of-emergency medication, and none of us are emergency-proof. glucagon, quite literally, can be the difference between life and death.

I’m glad you’re planning to get your roommates on board. And I’d bet they’ll be even more relieved to know how to help you than you will be to have them know. What I mean by that is that there’s nothing worse in the world than being powerless. Your roommates, on some level, already know that you’re a potential ticking time bomb. Now if something “bad” happens they can take direct action to help save your life, rather than just dial 911 and pray for you while they wait for the ambulance.

Everyone in my house knows how to use the kits. Well, more correctly, all of the humans who live under my roof know how to use them. Training the cat didn’t work out so well. Hypo dogs we got, glucagon cats are going to take some work.

The day after my son Rio turned 5, I sat down and had a conversation with him about glucagon. “Now that you are a man…” And I trained him how to use it. When the kits expire, we use them to run practice drills. He’s dying to use one on me. FYI, I talked a little bit about how and why they work here and here, so today we can focus on the how-to-enlist-other-folks-to-help-you issue.

As to your officemates, I might not have the most objective perspective in the world, as everyone at my office job knows I have diabetes, we have a gazillion BGL meters, dozens of glucagon kits, and the vast majority of my coworkers know how to use them. Of course, I run the diabetes education and treatment program for a FQHC clinic—not exactly the “typical” office environment.

How do non-clinical people deal with their diabetes at work? It’s as variable as flu viruses. Some PWDs hide their diabetes. Some are low-key about it. Some are open about it. Some flaunt it. Readers, I invite you to chime in today via comments on how you deal with your D at work.

Now, I don’t know what kind of work you do, Hannah, or what your office politics are, but I think someone there needs to be “in the know.” It could be a close co-worker; or maybe a reliable co-worker that you don’t even like. It might be a supervisor. Or the janitor. It really doesn’t matter. But you need someone on your team at work, because diabetes really is a team sport. And really, two someones would be better, just for in case your primary someone is out to lunch or on vacation when the Hypo Reaper pays you a visit.

How do you breach the conversation? Well, as a way of starting this rather awkward conversation, you could just print out this column and hand it to the person in question.

Or maybe just this part of it:

Or you can just memorize the lines above and say it to the person directly.

Now, your Lifeguard doesn’t need to know a damn thing about medicine to use a glucagon kit. Actually, that’s sort of the point. Who wants a fire alarm that only a fireman can pull? There’s a lot that ”laymen” can do to help each other, health-wise. That’s why we have CPR. That’s why we have AEDs (defibrillators). Do you know how many lives have been saved with citizen-operated public AEDs? About 1,000 a year. If there were more out in the field, some estimates say that 50,000 heart-attack deaths could be prevented every year.

But back to glucagon. Nowadays most states have programs for training non-medical school personnel on how to use glucagon for type 1 kiddos, although it was a long fight against school nurses to make it happen. Here’s a training outline from California, another from Utah, and another from New York. I think that pretty much gets us from sea to shining sea. You can glance these over for ideas, but don’t let the length of the documents freak you out. Giving a glucagon shot isn’t rocket science. It only takes about 90 seconds to mix the water with the powder inside the vial and draw it back out into the syringe before injecting.

But probably the easiest way to prep your Lifeguard is to simply have them watch a 2-minute YouTube video showing how to use a glucagon kit.

Novo Nordisk makes an inert “training” version of their glucagon kit, called HypoKit® Test Medium. It’s not the real deal, but it comes in a white box instead of an orange one so you don’t get the two confused, and the training kit even comes with an injection pillow for practice. You can call Novo and beg them to send you one, or your doc can request one for free here. Lilly also has a glucagon app available for free on iTunes to use as a training tool for anyone who might need to administer the fast-acting glucose boost in an emergency. Both are great ways for your Glucagon Lifeguard to get some hands-on experience.

Of course, once you get someone—or several someones—on your side, everyone needs to be on the same page about where the glucagon kit is going to live at your office. Again, I’ve got it easy at work. There’s one in our ER, one at the nurses’ station, one in the lab, several in our pharmacy, and one in my office velcroed to the wall right above the fire extinguisher.

What? Oh. No, those aren’t all for my benefit. We have a lot of D-folks in the building on any given day. Do you need yours velcroed to the wall? Why not? Or it can be in your desk drawer. Or in the desk drawer of your Lifeguard. Unless those desk drawers are as messy and cluttered as mine are, in which case stick with sticking it to the wall. But it really doesn’t matter where it is, so long as it can be found quickly. It should also be near wherever it is that you spend most of your time in the office. Oh. Right. And you should also have a kit at home and one in your purse or Go-Bag.

So do I think you’re being weird for thinking about this? Not even. Not at all. I think you’re being responsible. Responsible both to yourself and to those who love you.

And you’re right: your mother has already given enough to this damn disease. Get yourself a Lifeguard.

Disclaimer: 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.