Editor’s Note: This content has been verified by Marina Basina, MD, a Clinical Associate Professor at Stanford University. She’s a clinical endocrinologist and researcher with a focus on diabetes management and diabetes technology. Dr. Basina is an active member of multiple medical advisory boards and community diabetes organizations, and she is on the Beyond Type 1 Science Advisory Council.
Open the Lid and remove the Device from the Tube. Caution: Do not press the Plunger until ready to give the dose.
1) Hold Device between fingers and thumb. Do not push Plunger yet.
2) Insert tip gently into one nostril until finger(s) touch the outside of the nose.
3) Push Plunger firmly all the way in. Dose is complete when the Green Line disappears.
4) Call your emergency care immediately. Turn the diabetic on his or her side, (glucagon may induce vomiting). Continue to monitor the diabetic while waiting for help to arrive. The glucagon, though fast acting, will take a few minutes (around 10-15) to take effect.
5) You will need to continue to closely monitor blood sugars throughout the day after this, as a glucagon use will raise blood sugar substantially, but you will usually have an after effect of going low again. There is also a greater risk for another severe low for 24 hours after glucagon use. Because glucagon depletes the excess glucose storage in your system, some doctors recommend running your BGs a bit higher for a few days following glucagon use to help restore emergency sugars.
6) Restock! After the ordeal is over and BGLs have returned to a safe range, don’t forget to restock. Glucagon is a MUST-HAVE medication for diabetics, so when the unexpected occurs, you’re prepared. Use your expired glucagon for practice on an orange as well!
BAQSIMI demo from AADE 2019
How to use Gvoke Hypopen®►
In September 2019, the FDA approved the Gvoke HypoPen, an emergency glucagon rescue treatment for severe hypoglycemia. The device from Xeris Pharmaceuticals contains a room temperature, liquid-stable form of glucagon that is auto-injected when pressed against the body, similar to how an EpiPen works to treat severe allergic reactions. Gvoke is formulated for use in patients over the age of two and can be administered by caregivers in emergency situations of hypoglycemia.
Also approved was the Gvoke PFS, a pre-filled syringe with the same liquid-stable form of liquid glucagon found in the HypoPen. Both options will be available in two doses: a 0.5 mg/0.1 mL dose for pediatric patients and a 1 mg/0.2 mL dose for adolescents and adults. The Gvoke PFS (pre-filled syringe) is now available by prescription for home delivery (powered by PillPack, an Amazon company) and at local pharmacies through their preferred wholesalers. The company still expects to launch Gvoke HypoPen™ in 2020.
Use ZEGALOGUE exactly how your healthcare provider tells you to use it
Make sure your caregiver knows where you keep your ZEGALOGUE and how to use ZEGALOGUE the right way before you need it
Your caregiver must act quickly. Having very low blood sugar for a period of time may be harmful
Your healthcare provider will tell you how and when to use ZEGALOGUE
After giving ZEGALOGUE, your caregiver should call for emergency medical help right away
Once you are able to safely consume food or drink, your caregiver should give you a fast-acting source of sugar (such as fruit juice) and a long-acting source of sugar (such as crackers with cheese or peanut butter)
If you do not respond to treatment after 15 minutes, your caregiver may give you another dose, if available
Tell your healthcare provider each time you use ZEGALOGUE. Your healthcare provider may need to change the dose of your other diabetes medicines
How to use Glucagon Emergency Kits (GEK)►
1 – Make sure your hands are clean.
2 – Open glucagon. You will find a large syringe filled with liquid as well as a small bottle containing either a powder or a tablet. There will also be a page with instructions.
3 – Remove needle cap from syringe.
4 – Empty syringe into bottle with tablet / powder. It should start dissolving.
5 – Take syringe out and place to the side, but keep sterile.
6 – Gently swirl the vial containing the liquid and powder until it is dissolved.
7 – Using the same syringe, insert the needle into vial and draw out the mixed glucagon liquid. The general guidelines are to use half a syringe for Children 44 lbs. or less and a full syringe for those that weigh more than 44 lbs.
8 – Select area to inject glucagon and clean surface of skin. You should pick a large fleshy area such as thighs or buttocks, though an arm or the stomach works as well. Once you have identified the area, wipe with an alcohol swab.
9 – Insert needle of syringe fully into skin at a 90 degree angle. Once syringe is in, inject the glucagon liquid. It is best to do this as swiftly as possible, especially if the diabetic is having seizing and moving around. Try to keep the diabetic as steady as possible while you are injecting the glucagon.
10 – Once all liquid has been emptied, remove and safely discard the used syringe. If you have left over liquid in the vial from only using half a dose, this mixed liquid can be stored in the fridge for up to 24 hours, but no longer.
11 – Call your emergency care immediately. Turn the diabetic on his or her side, (glucagon may induce vomiting). Continue to monitor the diabetic while waiting for help to arrive. The glucagon, though fast acting, will take a few minutes (around 10-15) to take effect.
12 – You will need to continue to closely monitor blood sugars throughout the day after this, as a glucagon use will raise blood sugar substantially, but you will usually have an after effect of going low again. There is also a greater risk for another severe low for 24 hours after glucagon use. Because glucagon depletes the excess glucose storage in your system, some doctors recommend running your blood glucose levels (BGLs) a bit higher for a few days following glucagon use to help restore emergency sugars.
13 – Restock! After the ordeal is over and BGLs have returned to a safe range, don’t forget to restock. Glucagon is a MUST-HAVE medication for diabetics, so when the unexpected occurs, you’re prepared. Use your expired glucagon for practice on an orange as well!
Glucagon demo from athlete Robin Arzon
What is glucagon?
Besides being a hormone that occurs naturally in the body, glucagon is also an emergency medicine used when a person with diabetes is experiencing severe hypoglycemia (low blood sugar) and cannot take sugar orally or in non-emergency situations with mini-dosing to prevent “glycemic overshoot.”
Once injected, it raises the blood sugar by sending a signal to the muscles and liver (where glucose is stored in your body). The effect of glucagon is opposite of the effect of insulin, raising blood sugar instead of lowering it. It comes in several forms including a nasal spray, auto-injectors, prefilled syringes, or a powder that must be mixed with a liquid before injecting.
Types of Emergency Glucagon
While there was only one option for decades—and it was complicated to use—there are many new and improved emergency glucagon treatment products available today, including:
Glucagon pen – Gvoke HypoPen®: This is a premixed glucagon injection that you press against your thigh. The auto-inject device makes it quick and easy to use. It is also available in a prefilled syringe (PFS).
Glucagon Prefilled Syringe – Gvoke Kit®: This is a premixed glucagon in a vial that comes with a syringe, allowing you to draw up the dose manually and inject it directly into your thigh.
Glucagon pen – Zegalogue®: Also a premixed glucagon, available as an easy-to-use auto-inject device. It is also available in a prefilled syringe (PFS).
What is the difference between glucagon and insulin?
In people with a fully functional pancreas, insulin and glucagon work in tandem to keep blood sugars stable. Insulin lowers blood sugar, while its partner, glucagon, releases the body’s glucose reserves from the liver to raise blood sugars.
When do you use glucagon?
In emergencies
If you are conscious but cannot consume sugar orally, you can self-administer glucagon. If you are unconscious, someone else will need to inject the glucagon into muscle or administer nasal glucagon to the nostril. If hospitalized, an injection may be given intravenously. Always contact emergency services if glucagon is administered in an emergency situation.
In management
In cases of hypoglycemia (low blood sugar), glucagon allows the body to release sugar into the blood stream, so blood glucose levels can elevate to a safer range. Consult a physician to see if it would be helpful to use glucagon in glycemic overshoot prevention. It is important to note that glucagon may not work effectively if a person has been consuming alcohol.
How to store glucagon?
When not in use glucagon should be stored at room temperature. Do not freeze or refrigerate and keep away from direct sunlight. If using for mini-dosing, opened glucagon can be stored in the refrigerator for 24 hours.
What can cause hypoglycemia?
Too much insulin causing an “insulin reaction”
Not eating when scheduled to eat
Being sick (excessive vomiting or diarrhea)
Excessive exercise
What are symptoms of hypoglycemia?
anxious feeling
behavior change similar to being drunk
blurred vision
cold sweats
confusion
cool pale skin
difficulty in concentrating
drowsiness
excessive hunger
fast heartbeat
headache
nausea
nervousness
nightmares
restless sleep
shakiness
slurred speech
unusual tiredness or weakness
Untreated hypoglycemia will cause convulsions (seizures), unconsciousness and possibly death.’
Possible side-effects of glucagon:
nausea
vomiting
rash
itchy skin
If the following occur, call your physician immediately:
difficulty breathing
unconsciousness
Educational content related to severe hypoglycemia is made possible with support from Lilly Diabetes, a former partner of Beyond Type 2 and Xeris Pharmaceuticals, an active partner of Beyond Type 2 at the time of publication. Editorial control rests solely on Beyond Type 2.
High blood sugar isn't the only thing people with diabetes need to watch out for, but low blood sugar, too. Boost your awareness about hypoglycemia here!