The Travails of Glucagon

As those of you who are living with type one diabetes already know, Glucagon in its emergency kit form is nothing short of a LifeSaver. It allows others, usually nearest and dearest others, to give you that quick fix for a hypoglycemic coma which reduces the need for calling in the emergency services and a trip to hospital. It is cheaper by far for all concerned than either of the former. So you would imagine that a Glucagon kit would be readily available for a reasonable price. You could be wrong on either count, depending on where you lived.

On our summer vacation in California my spouse went into a coma (travelling is frequently dodgy for diabetics). We had brought four kits with us from Turkey because our travel insurance did not cover ordinary chronic disease needs and in California calling out the emergency services is costly. The Glucagon in one kit was not good, so I had to use another from our precious lode. Some time later that week we thought to try to replace at least one of these kits; but what would it cost, leaving aside the cost of seeing a doctor for the necessary prescription? Effectively, we were without insurance for the kit; but I had once checked into the cost of a kit from Eli Lilly and seemed to recall that it was in the region of $130. Exorbitant, yes, but it is a LifeSaver. Imagine our shock-horror to find that without insurance coverage (when it costs about $35) pharmacies were more than willing to think of a number, double it and then charge more! Prices in excess of $300 were quoted at supposedly reputable chain pharmacies. My spouse said no way. We managed throughout the rest of the stay on glucose jelly and hope. We needed at least a couple of Glucagon kits to get us to Mexico, to where we were moving, so did our best to avoid using the rest of the stache.

Before we set out for Mexico we checked into the availability of Glucagon; and we also tried to find out from Walmart whether or not their glucose jelly and tablets were available in their stores with pharmacies. Walmart never responded to our email enquiries (at least here in Tampico Walmart does NOT stock either glucose jelly or its own glucose tablets; nor does it stock its own glucometer and test strips). As for the Glucagon, or Glucagen (Novo Nordisk's brand) we found out that it was available. We felt somewhat more secure.

Within a few days of our arrival in Tampico, Mexico, my spouse had another coma, during the day at work. I was able to give him some glucose jelly, tiny spot by tiny spot rubbed into the inside of his cheek; by the time the ambulance had arrived he could almost communicate. Rather than give him the intravenous dextrose there on the spot, the paramedics carried him on a stretcher to the ambulance and closed the doors, refusing me entry. (There was a doctor there in charge of using the intravenous needle, I suppose.) Normally, my spouse refuses point blank to be taken to hospital, and he was protesting strongly against it this time; but his refusals were ignored. So he, and I, were taken to a private hospital where he was kept hooked up to one fluid or another (more dextrose then saline) for a couple of hours. While waiting agitatedly for our release, we asked about Glucagon. The thought of another episode like this one was not appealing - and would undoubtedly be expensive (his workplace paid this time). Glucagon? Who uses that? Here diabetics, we were informed, are maintained so as not to go into comas! Tight Control regimens do not appear to exist in Mexico.

Undaunted with this news we sought information from Eli Lilly here in Mexico via email. Glucagon is available here - on prescription (unlike syringes which can be bought over the counter) of course. The cost, without insurance? About $68. Of course we have yet to go to a doctor and ask for a prescription. That will be the acid test of its "availability". Private hospitals here clearly have a stake in Glucagon not being readily available. The cost to type one diabetics here may well be much greater over the long term, however. The only way to avoid hypoglycemic comas in type one diabetes is to maintain a higher than optimal blood glucose. With a generally high blood glucose comes the likelihood, if not the certainty, of cardio-vascular disease, kidney disease, ophthalmic ailments and polyneuropathy, with its attendant greater risk of injury induced gangrene. Of course, one avoids the possibility of earlier death by hypoglycemic coma.

In the sum of things, perhaps there is not that much difference between the US and Mexican systems: the making of profit out of illness and disease rather than doing everything to provide a vital service at the least cost to all.