Hypoglycemia and the future of glucagon therapy

If you've ever experienced increasingly low blood sugar, known as severe hypoglycemia, you already know that it can be a scary situation. Not only do you feel awful, but you need to get your blood sugar up quickly, and you may be dependent on other people to help you find fast-acting carbohydrates to help you do that. Glucagon therapy is a safeguard against severe hypoglycemia, and it can help even when there are no carbs to be found. Here's the latest on next-generation glucagon therapy for people living with diabetes.

What is glucagon?

Glucagon is a hormone that encourages the liver to break down stored glucose (sugar) and release it into the bloodstream. Glucagon also encourages the liver to make extra glucose.

Both insulin and glucagon are secreted by the pancreas, and they work in tandem to regulate blood sugar. Some people like to think of glucagon as the opposite hormone from insulin: Insulin promotes the movement of glucose out of the bloodstream and into the cells, while glucagon promotes the release of glucose from the liver into the bloodstream.

How does glucagon help people living with diabetes?

If you experience hypoglycemia, glucagon can be administered through an injection to quickly bring your blood sugar levels up. Glucagon will raise your blood sugar levels even if you're unable to eat or if you've become unconscious. Emergency medical services (EMS) might administer glucagon if they were called to help someone with very low blood sugar, but glucagon is available by prescription to people who need it. In short, glucagon is a lifesaver, and anyone living with diabetes who uses insulin should have access to it.

Next-generation glucagon

Previously, glucagon kits were cumbersome. They came as powder and water that had to be mixed when needed, and then they were injected using a large-gauge needle. One study found that caregivers of people with diabetes administered glucagon correctly only 13% of the time and that none of those people's acquaintances were able to administer glucagon correctly. Incorrectly administering glucagon results in a less-than-ideal improvement in hypoglycemia, and this is a serious consideration for people living with diabetes.

Thankfully, we now have next-generation glucagon. The Food and Drug Administration has recently approved three different options for increasing blood sugar during a hypoglycemic event. Each of these medications is considered a "next-generation glucagon" because it doesn't require you to mix a powder with a liquid before use.

• BAQSIMI is a dry nasal spray produced by Eli Lilly. It's approved for adults and children ages 4 and up.
• The Gvoke HypoPen is a pre-filled autoinjector, similar to an EpiPen. Gvoke is approved for adults and children ages 2 and up.
• Produced by Zealand Pharma, ZEGALOGUE is the most recently approved next-generation glucagon therapy. It's available as a pre-filled syringe or as an autoinjector, and it's approved for adults and children ages 6 and up.

When to use glucagon

Any blood sugar level less than 70 milligrams per deciliter is considered low, and often a low in the 60s can be treated with fast-acting carbohydrates like juice, hard candy, or glucose tabs. Glucagon is meant to be used during severe hypoglycemia, usually when your blood sugar level is less than 55 milligrams per deciliter. When your blood sugar is very low, you may seem confused, lack coordination, or even lose consciousness. It's urgent to get your blood sugar up right away, and that's when glucagon comes in. Glucagon can be used even when you're unable to eat or drink, and one study showed that it's equally effective whether administered as a nasal spray or as an injection.

What to do after using glucagon

After using a glucagon kit, you should be turned on your side if you're unconscious, and EMS should be called immediately. If you're conscious, wait about 15 minutes and check to see that your blood glucose is on the rise. If your blood sugar is headed in the right direction, follow up with a meal or a snack as you normally would after a low, and continue to closely monitor your blood glucose levels. Whether or not you lose consciousness, always report the use of a glucagon kit to your healthcare team. If you frequently need glucagon, that might indicate you need a decrease in your insulin dose.

Other things to know about next-generation glucagon

Glucagon kits have different storage recommendations. Be sure to check the manufacturer's specifications so your glucagon will be as potent as possible when you need it. Like most medications, glucagon kits also have expiration dates and should be replaced when they expire to ensure they'll be effective during a low blood sugar emergency.

Manufacturers may offer coupons and recommend keeping several kits handy: at home, at the office, and anywhere else you spend a lot of time. Next-generation glucagon kits are easily administered by friends, family, and co-workers, so it's important to teach the people in your life where your glucagon kits are kept and how to use them in an emergency.

Interested in knowing more about new innovations in diabetes care? Take a look at the future of diabetes.