#789 Important Things to Know About Gvoke HypoPen® (glucagon injection)

November 14, 2022Scott Benner

Scott and Jenny discuss the important things to know about Gvoke HypoPen® (glucagon injection)

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to another episode of The Juicebox Podcast.

On today's podcast Jenny Smith and I will be talking about G voc hypo pet, we'll go over the construction of the device, its operation, where on the body you can use Chivo Capo pen. We'll also talk about when to start thinking about using glucagon. We'll talk about the people in your life that you should tell about your diabetes and see if they'd be willing to help you in an emergency. And if you should have to use Jeeva hypo pen, what do you do next? All of that and more on this episode of The Juicebox Podcast. G voc hypo pen has no visible needle and is a premixed auto injector of glucagon for treatment of very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. Before we get started today, I would like to tell you that xirrus has paid the host of this podcast that's me Scott Benner and his guest, Jennifer Smith, a fee to create this content. Hey, Jenny, how are you? I'm great. How are you? Scott? Thank you. I appreciate you doing this with me today. Of course, I have to say a couple of things here. We don't usually do this together. But nothing that is said here constitutes advice, medical or otherwise, always consult with a health care professional before making changes to a health care plan. Okay, Jenny, you're never here for that part.

Jennifer Smith, CDE 1:51
I'm not usually I'm assuming you just add that in at some point. Right?

Scott Benner 1:56
That is what happens. G voc is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor, starvation, chronic low blood sugar, or allergy to evoke High Blood Pressure hyperglycemia and serious skin rashes can occur. Call your doctor or get medical help right away. If you have a serious allergic reaction including rash, difficulty breathing or low blood pressure. Visit Jeeva glucagon.com/risk for more information. So I know you know this but a lot of people listening might not know that on December 31 2022. After decades on the market, Eli Lilly and Company is discontinuing distribution of their glucagon emergency kit. Yes, they are. So we're talking about the I mean, the one everybody must have right, the little red kit with a powder in it. And you Yep. What do you

Jennifer Smith, CDE 2:52
do? Absolutely. The the old time I've had many, many of them over the years and all of them have gone in the garbage as of the expiration that's on the package, and then I just refill it.

Scott Benner 3:04
We used to give them to art in school so the nurses could practice with them. That's a great idea. Yeah. Having said that, a lot of that's not necessary anymore, because there have been a lot of innovations in the glucagon market. For instance, jeuveau hypo pen where I'm holding the pen right now I have a trainer pen. It's not the actual one. I know you have it too. I do. This thing is super simple in terms of administration. So we're gonna go over how it works in just a minute. It's a pre mixed and ready to use glucagon option that has a reliable method of delivering during critical moments of severe hyperglycemia. So now because the glucagon emergency kit has been discontinued, people who have that Eli Lilly g k prescription will need to be prescribed a different option. Yes, you should talk to your healthcare provider about your options. But we're here today to talk about G voc hypo pen, because I think it's a terrific option. It is the glucagon that my daughter carries.

Jennifer Smith, CDE 3:56
Yes, it's also one that I have in the cupboard and multiple other places in my home. I travel with it. So it's great.

Scott Benner 4:06
You have it in your on your person when you leave the house. I do. Yes. Okay. Arden does as well. And I have to say that this is the first time in I don't know how long 14 or 15 years of diabetes that art has actually been able to travel with glucagon because of Jeeva hypo Penn's simple two step administration. Chico Kibo plan is designed for trained and untrained individuals to successfully use in emergency situations. People can even self administer G voc in certain situations. It allows diabetics and their loved ones to treat severe low blood sugar emergencies with confidence. G Bo Capo pen is a ready to use rescue pen that everyone on insulin would benefit from. G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit je voc Luca don.com/risk. It's gonna seem like I read that and I probably did, but I actually mean it seriously We're going to talk about the build of the pen. How it's used, which maybe couldn't be. I mean, like I said, two steps, there's not a lot to talk about.

Jennifer Smith, CDE 5:08
It's very simple.

Scott Benner 5:09
Yeah, yeah, we're actually going to talk about where you can use it on the body, and a lot else. So you have your pen in front of you.

Jennifer Smith, CDE 5:17
I, yes, it's actually just underneath my desk here. Let me grab it. What else is under your desk? Well, you know, I have a riser desk with a treadmill underneath it. So I have, you know, a desk space underneath to be able to pull out multiple things while I'm talking to people. And educating Well, you know, you have to be right. Otherwise, I'm like, I have to run out of the room for this, right? That's not helpful.

Scott Benner 5:41
No, so you have yours, I have mine. These are trainer pens, they're not real, but they're, you know, a facsimile of what you get when you use Chivo type of pen. So, I mean, it's about the length of a pen, and width of a tiny cigar, maybe, you know, a half inch maybe around,

Jennifer Smith, CDE 5:58
there's actually say simply, it's kind of about the size of an insulin pen. Honestly, like, you know, the barrel of it seems to be about like, and in terms of a pen size, you're right. It's like a thick marker, almost.

Scott Benner 6:12
Yeah, that's a great way to put it, it's like it's like a marker size. There's a window on it. So that you can see after the glucagon has been administered, I'm looking at Jenny holding it up, and a red cap on the end. So it is cap off. Then you see this yellow, and to it, you find a place on the body to use the pen. Now here's where you can use it on the front, abdomen left and right under your belly button. Yes, top to your thighs and upper arms. Press down. The window gets read once it's done administering. And that's it. It's in. That's pretty.

Jennifer Smith, CDE 6:50
I love the fact that you can also hear

Scott Benner 6:54
the clicks. Yeah.

Jennifer Smith, CDE 6:56
As it's working, right? You pull the red cap off, like you said, put it in the location. And you hear the click. And that's it's a great way. And then I love the viewing window. The fact that you can actually see when it's completely read and done. It's It's wonderful to know that it was completely lost. And then of course, counting to five. Once you see that is the next kind of important step.

Scott Benner 7:21
Right? Well, I have to say the minute I saw it, I thought my daughter can finally carry glucagon with her. Yes. I mean, I don't know how it's been for other people. But it was hard to find people in her life, to train to use glucagon. And now it's, I mean, it's, it just couldn't be easier. We Arden just moved into college. And we got her roommates together at a lunch and went over all of this not one confused face, nobody was like, Wait, I don't understand, you know, they don't see a needle. So that keeps them calm. You know, there's people who are not accustomed to using insulin, not accustomed to seeing needles. And these are the people who might be helping you when you need help.

Jennifer Smith, CDE 8:01
Correct the fact that there's no mixing, there's nothing additional you have to do to utilize this, like, you know, it's just pull it off, stick it in the right part of the body and click and count to five. That's pretty, pretty nice, especially from the fact of, you know, the the age group of people using this is to and up. Correct. So when we kind of look at that in terms of training people, both trained and untrained, if you'll call them professional versus unprofessional, clinician, et cetera, et cetera. It's a great device that you don't have to see anything. That's scary.

Scott Benner 8:42
Well, I'll share a story from right after Arden was diagnosed, we went to the food court and tried to do I think Arden had had diabetes for like six months, and everything was going like really well, we thought. So we got kind of heavy and gave her some food court Chinese food. And we got home put her down for a nap, she was only two. And a little while later, we heard this grunting coming out of her bedroom. And when I went in there, it took me a minute to figure out that she was having a seizure. So I picked her up and brought her out to where Kelly was, and we later on the floor. And I pulled out that red box. And I froze. We really did. She had only had diabetes for six months. And the extent of what I knew about glucagon back then was that my doctor said, Here, take this, you'll never need it. Don't worry. And I thought when I heard that I was like, Well, there's one thing I don't need to know about right? But you really need to know about how to use your glucagon. And I learned it that day. We were very lucky to get Arden out of it with a glucose gel inside of her cheeks. But I mean, I was gonna say for the life of me but for her life I couldn't figure out

Jennifer Smith, CDE 9:50
how to and that's always a first step right. The first step is to try to get some simple sugar into the person or to be able to take it yourself But in the case that it's not going to work, and you could tell whether it's a finger stick or Now thankfully, we can see information on a CGM, then having GVL Capo pen would be a great thing to have with you.

Scott Benner 10:13
Yeah. Well, it's definitely I like you making that point. Because, you know, you don't use glucagon every day. It's, it's an emergency situation. And, you know, how do you figure out when that situation is real, especially in the beginning, before you have a lot of context for how quickly blood sugar's fall and rise? And you don't really know, you know, in the beginning, you don't really know like, did a Bolus like three hours ago lead to this is this you know, sometimes it feels like it's magical that your blood sugar is dropping and falling? Right. So let's talk about that for a couple of minutes. How do we know when to make the decision? What do you tell people?

Jennifer Smith, CDE 10:49
Yeah, that's a very good question. Well, again, as I just said, if you have treated with simple sugar, and you are following your CGM, or I always recommend trying to also do finger stick. But because we do know that CGM can lag a little bit, especially in the low blood sugar range, finger stick to be able to tell whether your glucose is coming back up. And if you are not thinking clearly enough to be able to make sense of your glucose data, then that's a time to use G Volkow pen, for example, right? Because if you don't know enough, but you know where this product is, it's better to use it. Other you know, situations for your caregivers, or the loved ones who you might have trained to use this product. Obviously, if you won't take something that somebody is offering you, that's the time for them to use this, right. And you know, all the symptoms and everything that come with hypoglycemia, some people get very angry and combative, and combative, exactly. That's don't try to feed somebody utilize this process.

Scott Benner 12:09
In a minute, I'm going to share a story that we have from more recently, which my daughter has come on the program and already shared back on another episode, but it begs repeating here for this. But for now, we have people around us, right? So not only do we need to know when to use the glucagon personally, right? If you're if you're an adult living with type one, or if you're the caregiver of someone, like wins that moment, and that moment, you know, if people are incapable taking things on their own, and they're being combative, you know, you have us you see a super low blood sugar you test and you see 20 And they can't drink or help themselves. This is the time right. It's it. Yeah, it's an emergency device. I know that's going to be a more difficult thing to decide when you're by yourself. I think I've taught Arden to err on the side of caution. Yes, she's by herself. Yes. You know, I said if you feel like you're going away, and you can't eat any type of sugar products, and things are getting confusing, you need to do it. It's in her bag that she carries with her everywhere. I have Chivo hypo pen in her side table in her dorm room. Everyone she lives with knows how to use it. The explanation we gave them and this becomes tricky because they are not diabetes mavens. Right? They don't know. No. So So we talked a little bit about Listen, insulin makes Arden's blood sugar go down. She could get confused pass out, you know, sweaty, faraway look in her face. You know, we went through a lot of ideas about how they could notice we show they all the common symptoms. Yeah, we showed her how we showed them how her her CGM works. One of the girls in the room follows Arden on a CGM. That's great. Yeah. And they know how to use her meter. Now, after so many years of diabetes, why did we go to that much trouble? Well, you know, it's because Arden had a seizure a couple of months ago before she left for college. So she's told the story on the podcast somewhere else. But I'm going to tell it to you in a brief way, because I'm really good at using insulin. And so as Arden and Arden uses an algorithm that tries to help her from getting low, and she hasn't been low like that since she was three years old. But it's still happened. And we weren't home. My wife and I were actually at my son's college graduation of all things. My daughter couldn't come with us because she had her prom. So a full day of activities, not a lot of food. I think they ate a meal at like 3am I don't think it was exactly good food that they had at 3am Her blood sugar's look terrific all day. If at two o'clock in the morning, you would have said to me Arden's going to get severely low four hours from now, I would not have believed it. Right. I just wouldn't have

Jennifer Smith, CDE 14:55
from looking at the data the way that it was and how everything had been trending thus far. You You wouldn't have expected it but there are probably a lot of variables in the picture.

Scott Benner 15:03
Well, what ended up happening was she had a meal about an hour after I finally went to sleep. She Bolus not a lot she knew not to give herself much but it was just was just too much. So, CGM beeps. My wife wakes me up. I call Arden on the phone. Hey, Arden, your blood sugar's low drink a juice, no different than any other time. She said, Okay. She drank the juice. I know she drank the juice. I said, Okay, go back to bed. And then I started getting ready for my day. And just a few minutes before it was time for me to get in the shower. Keeping in mind we're going to my son's college graduation. I think to myself, let me just look at Arden's blood sugar one more time. And I open it up and it just says low. So I call her back real quick. And she answers the phone. And I think Oh, great. And she says, Hello, but she sounded different. Like her voice sounded far away. And I said, Aren't you're low, you're really low drink another juice. And she goes, what? Am I garden? You're really low drink another juice. What? And that was it. She kept saying what I can't. What? And I know that juice was right next to her. So now I realize I'm I'm three hours away. And I know Arden's about to have a seizure. There are three of her friends, lifelong girlfriends in that living room sleeping around or on the floor. And I don't know what to do. So I scream as loud as I can into the phone. I started yelling the girls names because I tried to get Arden to say their names, but she wouldn't. She wouldn't. I was like Arden who's in the room with you. What? Who's there is Olivia there say Olivia's name. Nothing is Nadia there say Nadia name. Nothing. I knew not to say Sandra's name because she sleeps really heavy. And and so I started screaming. And then I heard Nadia stand up and say what do I do? And I said try to get her to drink a juice. So I can't see what's happening. Okay, okay, they're opening the juice up. They had switched handbags for the prom. So things were moved around. Then I hear Olivia's voice, what do I do? I say go to the drawer in the kitchen with all the diabetes supplies, get GVO Capo pen, it's in a pouch, rip the pouch open, be ready because of this juice doesn't work. You guys are going to administer this glucagon. And she's like, okay, okay. Okay. These are girls that have been around her her whole life. And if I wasn't there to talk them through it, I still don't know if they would have been okay. You know. And that's why it means so much to me to do this. And to explain to people that you, you can't just say to somebody, Hey, I have diabetes, and I might get low, but it probably won't happen. If it does and hold up the pouch and say use this, you know, you have to really make sure that they understand the significant nature of absolutely, you know, every time

Jennifer Smith, CDE 17:53
I throw one away on expiration and get the new one. I mean, my husband has heard this story so many times like this is what this is for it is right here. This is where we keep it we've always kept it in the same places. One is in the near his side nightstand and the other one is in the kitchen in the cupboard. The one in the kitchen in the cupboard is the one that comes in and out of the house with me. Whenever I'm going out, you know, biking to the park or biking around town or whatever with my boys. It goes in my backpack. My fourth grader knows exactly what it is. I've shown it to him. The little video online that actually shows pop the red cap off, push it in this part of mommy's body. No. But every time I bring it home, I go over that. Just as a review. Now that the product has changed from that old school Lily kit, right? This one being much simpler. I just go over this is where it is. This is when to use it.

Scott Benner 18:56
Now so prior to G vocab open, did your four year old know how to give you glucagon?

Jennifer Smith, CDE 19:00
Oh, my goodness. And I would have never expected I mean, I think that at this point. I think could I have trained my fourth grader on using the old school kit? I could have. They also know the other you know really important things 911 Dad's number on the phone and I our neighbors are typically on one side or the other usually always home within the daytime at least. I mean, they know some of the other really important pieces to do as well. But I don't think that I would have ever been I didn't I never trained them using the old kit. Because it's that's too much for a child of that age. In my opinion. It's it is

Scott Benner 19:47
I had trouble training adults with it. So because it's nice to say I'll be okay, but as an example during Arden's event, one of her three friends froze. Right she just froze was if it was just her, she would not have been able to help her. I mean, I maybe could have continued to talk her through it. But she was just, it's funny. And of the three of them. That's the one I thought would have been. I asked hardest. Yeah. And I got it. And instead, one of the girls who, you know, has been through some stuff in her life just sealed up and she's like, I got it. So now they're holding the hypopyon. And I said, they're like, are we gonna do this? And I'm like, is she drinking the juice? And she said, Yes. And the juice was going in and she was shaking and like elbowing the chair that she was in like, wildly. She was scratching herself with her nails from her prom. It was terrible. But she came out of it. She she had these big nails they had she had a rhinestones put on like fancy. Yeah, the rhinestone scratched her arms when she was kind of flailing around. So she started to come out of it. And we did not have to use the eyebrow pen. But it's great. We were we were it was there. I mean, I'm right. I'm like, open the package. This is it. If we don't see something in 30 seconds, we're doing this. So you know, luckily, she came out of it without it. But because of Jeevan hypo pen, I have very little doubt that one of those two girls could have done it. No trouble at all. Correct? Yeah, absolutely. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Please stay tuned for more important safety information at the end of this podcast. So then that kind of like brings us to Who do you tell? It's not just your son and your husband and your best friend who's going to be with you at your prom? You could be at a job. You could be at school, like we have. And then do you tell like you listen from my perspective? Jenny? You tell people. Correct. But do you think people do that?

Jennifer Smith, CDE 21:47
That's a really? It's a good question. I know that. My very good friends also knew at least about the old school kit. Right? They did they knew about it. Could they have used it? Maybe I took it with me to college. In fact, I had one in my backpack. I had one that stayed in my dorm room. My RA knew about it knew where it was in my room. My roommates all knew that I had diabetes. Some of them I knew previously. Some of them were brand new to me, and I just got to know them. But I don't know how many people honestly tell people I would guess that more kids and teens. Their parents tell a lot of people about using it, whether it's the school or their coaches or their PE teacher, their kids best friends that they're going to go over and have a sleepover or a birthday party at. But I think that if I had to estimate the number of people that may not tell enough people about it

Scott Benner 23:05
are adults. Yeah, that's what I'm worried about, like not wanting to tell people at work that you have diabetes even correct. Somebody's got to know, you know,

Jennifer Smith, CDE 23:12
right, right. I mean, I've had jobs in the past where I did not work within this field. Right, you know, going to college and whatnot. I mean, my, my job in high school, I worked at a PC believe this or not worked at an ice cream and candy shop. Great place. Right?

Scott Benner 23:32
That sounds good to me.

Jennifer Smith, CDE 23:33
I did I did bring my kit to work with me. My boss did know that I had it. But I don't know that I reviewed that more than one time in the whole number of years that I work there. Right. So

Scott Benner 23:51
well, I so I'm here to say I hope you tell people I hope that you get to vote hypo pan. It's you know, like you said the form factor. It's easy to carry. Tell people yes pick, please pick somebody you trust at work or at school or a teacher and make sure they know make sure. I think at high school like for example or in grade school people throughout the building. We want people throughout the building, not just one person that you know, you may or may not be with at the time,

Jennifer Smith, CDE 24:20
correct? Absolutely. And that may be you know, in grade school, middle school, you may only have a couple of people to talk to about it. But once you get to that high school age and or a college those are that's a lot of people moving around room to room classroom to classroom. You know, in college, I remember talking to each professor each semester and telling them you know, I might be eating in class because of this or if this happens, obviously, you know, call emergency and I have this thing I carry around in my backpack. This is what this is for.

Scott Benner 24:59
So you It occurs to me while we're talking. I bet you most people don't even know the process that happens after you inject the glucagon, do you think they think that what's in the pen makes your blood sugar go up? Because what really happens?

Jennifer Smith, CDE 25:14
Right? Yeah, that's Yeah, that's actually interesting consideration because I think most people probably do think that that's just, it's almost, I guess people might think that it's sort of like sugar just being pushed into the body.

Scott Benner 25:31
Right. But will you share with people what it's actually doing?

Jennifer Smith, CDE 25:34
Yeah, essentially, it's allowing your body to push out, its stored glucose sources into the body, right? It's creating enough oomph to actually bring out what your, what a normal body would typically do that, that pump and flow kind of between insulin and glucagon in the body, that helps to keep your blood sugar where it's supposed to go. So this actually helps to increase that delivery into the body and brings blood sugar up very quickly. Which is lovely.

Scott Benner 26:13
If I had to hypo pens, and I injected it into someone who was having a seizure unconscious, how long do I wait before I think, should I do it again, and is doing it again, the right thing to do? I mean, by then we've called 911, and everything, but how many times can you do it?

Jennifer Smith, CDE 26:29
By then? And I know that the typical is twice, right. So if once has not worked, that's why you get to high bullpens

Scott Benner 26:37
at a time when you get a prescription, yeah, when you get a prescription.

Jennifer Smith, CDE 26:41
So if obviously, it's also the reason that you call medical as soon as the first one is given you call 911 right away. And if the person does not come around, within about 15 minutes, then we do a second injection of G voc hypo pen.

Scott Benner 27:00
So there it is, right. We're in an emergency situation. If people can try sugary snacks or something they can I want to mention here not to force food into someone's mouth. Who's having a rancher? Because you they could aspirate. Right. Right? Yeah. So glucose gel on the cheek, you know, but if you're trying to squirt, you know, juice into someone's mouth, and it's running out the corners, you're going to choke them, you're not going to help

Jennifer Smith, CDE 27:26
them. No, right? No, that is not going to help them.

Scott Benner 27:30
So we said, we've used geolocate bullpen. And there's some steps to take, right? We're going to call 911. Correct right away, but the person needs to be rolled onto their side. Correct, okay, because,

Jennifer Smith, CDE 27:42
because the because they may vomit after the G Volk has been delivered. And essentially, it may cause some vomiting after blood sugar levels start to rise. And so you want to turn them on their side so that they don't essentially aspirate,

Scott Benner 28:01
okay. And even if you've got a Hypo pan helps the patient to wake up, we're still gonna call for 911,

Jennifer Smith, CDE 28:06
you still always just deliver it and call 911. That's what I've always told everybody, including my husband.

Scott Benner 28:15
Do we call our doctor afterwards and let them know this happened?

Jennifer Smith, CDE 28:18
Yes, absolutely. Because either it was a one time. And you you know, in your example, with Arden, you know, some of the variables that went into that, right, you have an idea that her doses are 99.9% of the time. They're right, they're doing what they're supposed to be doing. However, it's important to let your physician know, because they can also assess the data and help to evaluate and see, well, maybe there are some trends that you haven't seen yourself, and maybe some dose adjustment needs to be made. And if so, they're the ones to help you with that.

Scott Benner 28:58
So afterwards and someone wakes back up, does its job, you're awake again. You need to eat now Arden's thing like I said has even though in my heart, it felt like it took 20 minutes it was only a couple of minutes the entire thing. And finally one of her other friends woke up and I was like, Go get her some bread, something you know to eat, like something will sit in her stomach because she had had a couple of juices by then. And, and then was actually very funny because I know in the moment it wasn't funny, but going back later the one girl's like rooting around in the refrigerator. And I hear Olivia go, why are you in the refrigerator? You know they have a breadboard. We've been coming to this house for 10 years. Why are you looking for the bread in the refrigerator? She's like I'm sorry,

Jennifer Smith, CDE 29:42
I don't know I'm Oh, she was just flustered. She's

Scott Benner 29:45
like we keep the bread in the refrigerator at home so I can hear all this happening. Our artists waking up she's making sense you know, everything is okay. But you know, we got solid food into her after that.

Jennifer Smith, CDE 29:57
Right and I think an important piece To put in as well as that one low, especially a serious low such as this one. Another piece to teach is that another low could come, if you're not careful, you know, within a couple of hours are within the same day, it's very common to have a significant low and then potentially have another significant low. So it's really important, you know that you kind of lay low, right, don't go out for a 10 mile run four hours later.

Scott Benner 30:37
Maybe the rest of the day. Yes, the rest of the day is about relaxing. Well, that's what the girls did. So they had been asleep for two hours, right in the last 24 hours, and they couldn't they were all jacked up, they couldn't go back to sleep. So they just stayed awake. And it was it was I'm not gonna lie like it took more than a couple of days to bounce back from it psychologically. It was it was difficult for I'm sure

Jennifer Smith, CDE 30:57
it was absolutely.

Scott Benner 31:00
So I think you just need to, you need to be ready, you need to know what to do the people around you need to know what to do. And that's why we're doing this, about storing Jeeva Capo pen store in a sealed original foil pouch until the time of use so the pen I'm holding here would come in a pouch and the pouch actually has directions on it and they're really duds and they're good I have them here in front of me somewhere Do you have them too?

Jennifer Smith, CDE 31:22
I do the picture is very clear. Which is wonderful to see and very simple and there's not a lot of like intricate detail that makes it like you need a magnifying glass to read it but yes the directions are right on the package which makes it nice for somebody you know even though you're not going to see a needle or anything like the older kit and you may have instructed caregivers their loved ones already in that moment. It's nice to have a visual of Oh yes, I remember I do this picture I do this picture and this it's it's nice.

Scott Benner 32:00
I'm looking at it right here it's simple it says number one prepare tear open pouch on dotted line remove autoinjector pull off red cap, choose injection site and expose the skin push down on skin to start hold down for five seconds. Then the window turns red, turn the person on their side call 911

Jennifer Smith, CDE 32:18
Correct and I think you use you said something really important there expose the skin. You do not want to inject this through clothing expose the skin pull the clothes away if you have to pull somebody's pants down or pull their shirt off or whatever it is. This is necessary do not put it through the clothing

Scott Benner 32:39
I appreciate you saying that yes more about storage information so it stays in the foil pouch till time of use stored at room temperature between 68 and 77 degrees Fahrenheit or 20 to 25 degrees Celsius and you do not refrigerate or freeze it correct

Jennifer Smith, CDE 32:53
just shelf stable

Scott Benner 32:55
yes selfs just shelf stable there's just what did I just say? Jess shelf stable. That's what I tried to say yeah did not come out did it? She voc is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor starvation, chronic low blood sugar or allergy to evoke High Blood Pressure hyperglycemia and serious skin rash can occur. Call your doctor or get medical help right away. If you have a serious allergic reaction, including rash, difficulty breathing or low blood pressure. Visit Chivo glucagon.com/risk for more information. There's great information about Chivo hypo pen online. So Jeeva glucagon.com, you can use my link to vote glucagon.com forward slash juicebox Chivo glucagon.com. Forward slash risk all kinds of information. And throughout this episode I'm going to put put some of that safety information in here so people can can hear it as they're going.

Jennifer Smith, CDE 34:01
And there's a wonderful video online, just the intro video is super easy to watch. So if you physically want to, because the package is not, the package isn't clear, even though it shows you a picture of what it looks like. I think it's nice to see it being held in a hand what it actually looks like and go through the actual process. So it may be even something that you utilize. I've had a couple of parents who kind of use the video in school teaching, just to show makes Yeah, it makes it very visual when they can't have an open package because obviously you want to store it in the package.

Scott Benner 34:37
You know what after you leave me I'm going to at the end of this episode, I'll record a list of hypoglycemia symptoms. So that some case you're not in case you're listening and you're not sure. I'll go through a bunch of them for you so you can hear them there. That'd be great. Well, Jennifer, have we done it?

Jennifer Smith, CDE 34:54
I think we've done it. Yes.

Scott Benner 34:57
We're so good at this.

Jennifer Smith, CDE 34:59
Yeah, well You know, we've, we've talked often enough over the past couple of years that hopefully we would have covered things sufficiently. Yeah.

Scott Benner 35:07
Yeah. I appreciate you doing this with me very much. Because it just like I said, I, I didn't want to bring it up during the during this because it's your private stuff. But I know you've had like a low blood sugar, like through your life, and you've shared them on the podcast before. And the story you tell about, were you pregnant holding a younger child or something in a store? It's frightening to me. Oh, yeah. You know, because you're, because you're, you're so good at this. As you know what I mean? Like, that's the that's the thing, I guess I want to say to people, and I'll share this before we go. When I used to have to go into school every year and explain diabetes to Ardens. Teachers, I would tell them I'm not here explain to you everything that could go wrong, because it's definitely going to go wrong. Right. But it probably is. And when that time comes, I don't need you pulling out a piece of paper going. What do I do? What do I do? I want you to write I want you to react? Maybe it'll never happen. But I don't know. Right?

Jennifer Smith, CDE 36:08
Yeah. And if it does, then at least you have a plan and you've gone over it enough times that it's almost a second nature. Even if you've never used evoke hypo pen before you've gone over it enough that it becomes something that you plan to use. Even if you never

Scott Benner 36:26
do Yep. Danny thank you so much for doing this. Of course I'll see you soon. Sounds great. Fine. Before we go, here are some early symptoms of hypoglycemia.

Okay, some early symptoms of hypoglycemia, which of course is low blood sugar include sweating, drowsiness, dizziness, sleep disturbance, palpitations, anxiety, tremors, blurred vision, hunger, slurred speech, depressed mood, tingling in the hands, feet, lips or tongue, irritability, lightheadedness, abnormal behavior, inability to concentrate, unsteady movement, headache, or personality changes. If left untreated, these symptoms may progress to confusion, seizures, unconsciousness, and even death.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.