Mini-dosing of Glucagon in Everyday Diabetes Management
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 hypoglycemia and cannot take sugar orally. It comes in powder form and must be added to a solution in order to administer it. The effect of glucagon is opposite of the effect of insulin, raising blood sugar instead of lowering it.
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.
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:
- Nasal glucagon – Baqsimi®: This is an emergency glucagon that’s administered through your nose.
- 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 vial & 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. *This form of glucagon allows for micro-dosing.
- 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).
Glucagon and Type 1 diabetes
In contrast, people with Type 1 diabetes currently have only synthetic insulin available in their diabetes management toolkit to lower their blood sugar, and they must rely solely upon sugar-containing food sources to raise their blood sugar. Most people who are insulin-dependent keep a glucagon rescue kit handy in case of an extreme (and life-threatening) case of hypoglycemia, but mostly individuals with Type 1 feel grateful when they notice the kit collecting dust, unused.
Glucagon in Type 1 diabetes management
If the body uses glucagon naturally, can people with Type 1 benefit from using glucagon in non-emergency situations? The following are situations where mini-dosing of glucagon may be helpful in management.
It turns out that glucagon kit can come in mighty handy on sick days, when nausea and vomiting make eating and drinking nearly impossible and increased insulin sensitivity can cause blood sugars to fall rapidly. In the past decade, diabetes practitioners have become more comfortable with developing guidelines for administering small doses of glucagon (the “mini-dose”) to help with sick day management.
*See the below-referenced article by Haymond and Schreiner (2001) and the links to printable PDFs for glucagon dosing guidelines according to age, but, as with all things diabetes-related, ask your endocrinologist about his or her recommendations as well.
Always consult your physician for proper dosing. Mini-Dose Glucagon Rescue Protocol:
Substitute for sugars
Another potential benefit of using mini-doses over sugary snacks to treat hypoglycemia is that mini doses may prevent “glycemic overshoot,” or the tendency to overtreat low blood sugars with too many additional carbohydrates (Haymond, Redondo, McKay, et al., 2016).
Some adults and athletes with Type 1, who can struggle to maintain tight blood sugar control and nutrition goals, may wish they didn’t have to rely on glucose tablets, juices, and sugary snacks to correct their lows.
Parents of children with Type 1 may desire a more reliable method than snacks to raise their child’s low blood sugar during athletic events, or in the middle of the night when their child is asleep and difficult to wake up.
The problem with Glucagon in its current state
- Traditional Glucagon Emergency Kits (GEKs, in the red case) have very limited shelf life once mixed (about 24 hours). New nasal sprays and auto-injectors are also not usable for mini dosing. However, two brands make pre-filled syringes that should make mini dosing more accessible.
- The limited knowledge on the proper glucagon dosage by age and weight
- The expense of the kits
The closed-loop artificial pancreas system
The Beta Bionic’s iLet system, (awaiting FDA approval), not only gives automatic dosing of insulin but also of glucagon, the vital hormone for bringing blood sugar up and preventing potentially life-threatening hypoglycemia. Created by Ed Damiano, a professor of biomedical engineering at Boston University, this device is proposed to be the ultimate artificial pancreas, able to administer correction doses 24/7 for both hyperglycemia and hypoglycemia. Trials for the iLet device begin fall of 2017 and will be more extensive with the addition of the hormone glucagon.
Haymond, M. W., Redondo, M. J., McKay, S., Cummins, M. J., Newswanger, B., Kinzell, J., & Prestrelski, S. (2016, March). Nonaqueous, Mini-Dose Glucagon for Treatment of Mild Hypoglycemia in Adults With Type 1 Diabetes: A Dose-Seeking Study, Diabetes Care, 39(3), 465-468. Retrieved January 18, 2017.
Haymond, M. W., & Schreiner, B. (2001, April 24). Mini-Dose Glucagon Rescue for Hypoglycemia in Children With Type 1 Diabetes, Diabetes Care, 24(4), 643-645. Retrieved January 18, 2017.
Idlebrook, C. (2016, July 22). Glucagon the Sole Focus of a Bionic Pancreas Trial, Insulin Nation. Retrieved January 19, 2017.
Leach, C. (2013, July 17). Harnessing Hypos: Glucagon As An Everyday Tool, Insulin Nation. Retrieved January 18, 2017.