The Low Blood Sugar Fire Drill

By Darren Bolton

Chalk it up to a “life lesson” that was well-learned and safely resolved. Sometimes you get thrown an unexpected curveball, just when you think you have everything under control. Here’s my story.

When I was first asked to write this article about managing an emergency low-blood-sugar episode for Countdown, I was not sure how I would cover it, since I had never experienced dangerously low blood sugar. So I contacted my endocrinologist, Stuart Brink, M.D., a two-time secretary general, former president, and current international education chair of the International Society for Pediatric and Adolescent Diabetes, who suggested that I enact a type of “fire drill” with friends, family, or significant other. The assignment was that I would pretend to experience a serious low blood sugar episode to test their response—essentially to ensure that they would be ready should a real emergency ever present itself.

Dr. Brink explained that before hosting the drill, I should cover several important topics with my friends and family, including how to ascertain when I have low blood sugar, where I store my glucagon kit, how to administer the glucagon, and what emergency numbers to call as a backup. Once these topics had been covered, I would surprise my “students” with a fake low blood sugar attack. I would simply state that I have severe hypoglycemia, and then sit back quietly and allow them to respond as though it were a genuine emergency.

“When someone has mild hypoglycemia, they are able to take care of themselves even with the low sugar levels,” says Dr. Brink. “Moderate hypoglycemia requires assistance from someone else. Severe hypoglycemia means that the person either has lost consciousness or is actually having a convulsion. Knowing the causes of hypoglycemia enables family and friends to recognize it and respond properly.”

Ironically, I experienced my first hypoglycemic episode two weeks after I agreed to write this article. My girlfriend Courtney and I were out celebrating a friend’s birthday and I had quite a bit to drink. When we got home to the apartment she shared with a roommate, I went straight to bed and passed out without checking my blood sugar or eating a snack. About two hours later, Courtney awoke to find me lying in a pool of sweat. I was so drenched that she thought I had peed in the bed. Immediately sensing that there was a problem, she started shaking me but I remained completely unresponsive, save for a few groaning noises. She began pleading with me to check my blood sugar, and even threatened to call 911. When these measures proved ineffective, she realized that she had a real emergency on her hands.

After a brief talk with her roommate, they decided it was imperative that they call 911. In Courtney’s words, “The 911 operator advised me to give juice to Darren to get his blood sugar back up, but I didn’t even have that temporary remedy in the house.” She could have used table sugar spooned into my mouth, but the operator did not suggest that, and Courtney had not been taught that option. “The operator then advised me to mix sugar into milk, which I did,” says Courtney. “Unfortunately, Darren’s level of unconsciousness was so severe he was unable to drink. The only thing we could do was wait for the paramedics to arrive. I was helpless.”

The paramedics arrived quickly, and wasted no time in giving me a glucagon shot. After regaining my senses, my first memory was of the EMTs telling me that I needed to come with them in the ambulance for a brief period of observation at the hospital. With my head still in a fog, I got dressed and carried myself out to the ambulance with whatever dignity I could muster. I felt so terribly irresponsible because I had considered myself immune to the risk of having a serious episode like that—boy, was I ever wrong. I realized then how completely powerless I was to help myself.

There is no doubt that the timing of this whole incident was ironic. I was asked to write a piece on preparedness for low blood sugar emergencies, and almost immediately afterward I experienced a life-threatening episode of low blood sugar. I was put into a situation for which I personally was unprepared. After this whole ordeal, the fire drill itself became sort of anticlimactic, although I still decided to go through with it.

I decided that I would enact this hypoglycemia fire drill with Courtney, because she is the person with whom I spend the most time, and I wanted us both to feel secure if we had to deal with another real-life episode.

During the fire drill, Courtney immediately knew where to find my glucagon kit this time around. I had her use an old needle to mimic the act of filling the syringe from the vial, and then watched her inject the syringe into an apple. She was calm and composed, having already experienced her trial by fire. Really, the whole drill was academic. I felt secure knowing that if I were ever to have another low blood sugar emergency, I was in good hands. Even if the drill had been her official introduction to a low blood glucose emergency, I still felt confident that she had the necessary training to care for me properly.

Courtney’s take on it was fairly matter of fact. “The afternoon we got home from the hospital I made Darren teach me how to test his blood sugar level with his testing kit. A few weeks later, when the glucagon kit came in, we went through all the steps again. Then one day Darren pretended he was having another episode to test my preparedness level in case, God forbid, another severe low blood sugar situation should ever arise. This time I knew exactly what to do.”

About the author

Darren Bolton has had T1D for 11 years. For eight of those, he has been writing for the Online Diabetes Support Team at JDRF, and has done some additional writing and editing for JDRF’s Adult T1D Toolkit.