The New Normal: Glucagon Ready to Go

The COVID-19 pandemic has ushered in new behaviors we are quickly adopting to stay safe. Wearing masks and social distancing are just a few behaviors described as the “new normal”. If you have diabetes and use insulin, then you and your loved ones also have a “new normal” for being prepared and ready to manage severe hypoglycemia: the latest option in glucagon delivery.

“I have shared my glucagon kit with others like my martial arts instructor, coworkers and even  girlfriends, but it provokes a lot of fear and awkwardness,” says Andrew Young, TCOYD Board Member and President of Healflow. Andrew developed type 1 diabetes in his twenties. He is not surprised by the shock and anxiety from others who say, “Whoa, I don’t think I can remember how to do that.”

For the past 60 years there have been only two recognized options for treating low blood sugar—use the cumbersome multi-step traditional glucagon emergency kit or call 911. Fortunately, the past 12 months have provided new options that deliver glucagon in ready-to-use formulations.

Both Eli Lilly’s Baqsimi^® (glucagon) nasal powder and Xeris Pharmaceuticals’ Gvoke^™ PFS  (glucagon injection) pre-filled syringe are approved and have been available since 2019. Now Xeris has released the Gvoke HypoPen^™ (glucagon injection), the first autoinjector for treatment of severe hypoglycemia.

Gvoke HypoPen is a familiar autoinjector containing premixed and premeasured glucagon that is ready-to-go. No mixing or fumbling with the device—just remove the red cap and press the yellow end on bare skin for 5 seconds until the window turns red. The red window indicates a full dose is delivered (see figure below). No one—including your friends or loved ones—ever sees the needle. Gvoke HypoPen comes in two different dosage strengths – 1 mg for adults and 0.5 mg for children 2 to 12 years weighing under 100 pounds. Gvoke HypoPen is stable at room temperature for 24 months after manufacture date.

Marlon Blanquart, a UCSD biology student and president of UCSD College Diabetes Network, says he never shared when and how to use glucagon with roommates or friends. “The old kit was intimidating to others and so bulky I didn’t want to carry it,” said Marlon. Instead, he carried around a 40-ounce bottle of Sprite containing 80 grams of carbohydrate, in the event he needed to treat hypoglycemia. Marlon recalled that on two separate occasions he mistakenly took too much insulin to cover his food intake. He realized the problem when his trend arrows headed downward. Unfortunately, gulping down 40 ounces of Sprite did not treat his severe low and he passed out. His mom saw the problem on his shared CGM and called the paramedics who, Marlon said, “Came bursting into my dorm room to administer IV glucose.”

In the new normal, Marlon’s dormmates could have known where he kept his ready-to-use glucagon and easily administered it with one of the new glucagon options. Gvoke HypoPen is a reliable method to quickly deliver glucagon; 99% of people in a usability study (trained and untrained, adolescent and adult caregivers) were able to successfully deliver a full dose of glucagon during simulated emergency situations¹.

Andrew’s experience was similar to Marlon’s, but the outcome was different. Andrew took an insulin dose that would have covered his meal. Alarmingly, his CGM trend arrows kept going down with no apparent prospect of going back up. He frantically ate more food. Nothing happened. Andrew lives alone. He took out his traditional glucagon kit. His blood sugar was still stubbornly staying below 50 mg/dL. Andrew was able to think fast, and despite the cumbersome preparation process was able to give himself a dose of glucagon.  Andrew says, “The experience was scary, trying to eat despite being full.” Gvoke HypoPen provides a ready-to-go, easy-to-use form of glucagon that could be self-administered. Andrew stated, “Something that is easy to use and less bulky to carry in my pocket could increase my confidence that I can always have access to glucagon.”

Glucagon can be expected to raise blood sugar to a safe level within 15 minutes, but the effects are short-lived. So always make sure a snack or meal is consumed shortly after recovery from a severe low. Studies with Gvoke HypoPen demonstrated an average blood sugar increase of 123-176 mg/dL.

Glucagon is so important to diabetes management that the American Diabetes Association recommends all persons at risk for severe hypoglycemia (blood sugars below 54mg/dL) have glucagon that they keep with them.² If you use any type of insulin, you are at risk for severe hypoglycemia. It doesn’t matter how old you are, what your A1c is, or whether you are on an insulin pump or CGM—severe hypoglycemia is a possibility. As with Andrew and Marlon, lifestyle factors like erratic eating and exercise schedules, mistakes in insulin delivery, drinking alcohol on an empty stomach, illness or stress can cause hypoglycemia.

The new normal is having a simple portable form of glucagon that is there when you need it. Accessibility to ready-to-use glucagon, like Gvoke HypoPen, is important for friends, family, coworkers, teachers, and coaches who could assist you in managing severe low blood sugar.

Gvoke HypoPen is available in 2-packs.  You can learn more about Gvoke HypoPen at www.GvokeGlucagon.com.

How to Use Gvoke HypoPen:

Written By: Christine Beebe and Kathleen J. Chavanu, PharmD, Xeris Pharmaceuticals

References:

1. Valentine V, Newswanger B, Prestrelski S, Andre AD, Garibaldi M. Human Factors Usability and Validation Studies of a Glucagon Autoinjector in a Simulated Severe Hypoglycemia Rescue Situation. Diabetes Technol Ther. 2019;21(9):522-530. doi:10.1089/dia.2019.0148
2. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl.1): S66–S76