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Glucagon for Severe Hypoglycemia

Low blood sugars can be a scary part of life with diabetes, but being informed and prepared on how to treat hypoglycemia can make these moments less stressful. Glucagon is the best treatment option for severe hypoglycemia. 

What is glucagon?

Glucagon is a hormone that raises the level of glucose in the blood. The alpha cells of the pancreas, in areas called the islets of Langerhans, make glucagon when the body needs to put more sugar into the blood. Glucagon binds to a receptor on liver and muscle cells (called the glucagon receptor), stimulating the cells to release glucose.

For people with type 1 diabetes, the pancreas does not release insulin, making them unable to adjust insulin levels in response to glucose levels, and type 1 diabetes can also impede the secretion of glucagon, making them at risk for severe low blood sugars.

Everyone who uses insulin should have a form of glucagon on hand at all times to counteract severe hypoglycemia that causes loss of consciousness, or if sugar cannot be given. See below for the kinds of glucagon that are available.

One of the potential side effects of a rescue dose of glucagon -- regardless of the form -- is vomiting, so be sure to place the person on his or her side prior to administering so they do not choke. After administering glucagon, follow with food once the person regains consciousness and is able to swallow.

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BAQSIMI Nasal Glucagon

BAQSIMI, made by Eli Lilly, is the first and only dry nasal powder to treat severe hypoglycemia. Instead of an injection, BAQSIMI is administered as a puff in the nose. It is important to note that BAQSIMI can be given to a patient who unconscious, as it does not require being actively inhaled and can be used even if the patient has a congested nose.

How to dose BAQSIMI (from the BAQSIMI website)
How to dose BAQSIMI - image from the BAQSIMI website
Keep BAQSIMI tube sealed until ready to use.

The BAQSIMI device. Keep tube sealed until ready to use.

GVOKE HypoPen

The GVOKE HypoPen, made by Xeris Pharmaceuticals, is the first premixed autoinjector for very low blood sugar. GVOKE contains stable liquid glucagon and is available as a HypoPen and as a pre-filled syringe. Using the GVOKE HypoPen is an easy, two-step process, shown below.

How to use the GVOKE HypoPen, from Xeris. Click on the image for Important Safety Information on Gvoke.
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The GVOKE HypoPen.

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Injectable Glucagon Emergency Rescue Kit

For years, families relied on the glucagon emergency kit to treat severe hypoglycemia. These kits, made by Eli Lilly and Novo Nordisk, included dried glucagon and a diluent and had to be mixed immediately before using. Due to the complicated nature of needing to mix this kit in an emergency situation, these glucagon kits can be challenging to use in the stressful situation of severe hypoglycemia. Studies have shown that people are much more likely to administer a rescue dose of glucagon using BAQSIMI or GVOKE compared with the old glucagon rescue kit. However, the “older” glucagon emergency kits can be used for mini-dose glucagon rescue.

Rescue kits of glucagon can also be used, in small doses, to raise blood sugar when someone can't eat -- for example, when sick due to a stomach illness. This is called mini-dose glucagon rescue, and while it is off label, many people with type 1 diabetes report using it with great success. Talk with your clinical team about how you or your family can use mini-dose glucagon with confidence.

Photo by Jeff Hitchcock. Property of CWD.

Lilly's Glucagon Emergency Kit, opened.

Photo by Jeff Hitchcock. Property of CWD.

The syringe filled with diluent and the vial filled with the dry powder glucagon from the Lilly Glucagon Kit

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