What’s Up With All the New Glucagon Options? With Alissa Segal, PharmD


 

Editor’s Note: If you take insulin or any other blood sugar-lowering medication, you need glucagon. Learn about your options here.


Did you know there are multiple new and easy-to-use types of glucagon available these days? Used to raise blood sugars to safe levels during a severe low blood sugar (hypoglycemia) emergency, glucagon is now available as an auto-injector, nasal spray or in a pre-filled syringe. Copay cards and Patient Assistance Programs (PAPs) are available to help with the cost.

To talk about all of the new options, we sat down with Alissa Segal, professor at the Massachusetts College of Pharmacy and Health Sciences, and a clinical pharmacist and diabetes educator at the Joslin Diabetes Center in Boston.

Partial transcript of the conversation below, edited for content + clarity.

BT1: Hello everyone. My name is Lala Jackson. Today we’re going to be talking about all things glucagon, including all of the new glucagon options. We’re joined by Dr. Segal. She is a pharmacist and knows everything you need to know about all of the new glucagon options. 

Alissa Segal, PharmD: I’m Alissa Segal. I’m a professor at the Massachusetts College of Pharmacy and Health Sciences and a clinical pharmacist and diabetes educator at the Joslin Diabetes Center in Boston.

Thank you so much for joining me today. Can you tell us first, what is glucagon?

Glucagon is a hormone that’s secreted from the pancreas, similar to insulin. But what it does is in some ways, opposite of what insulin does. It causes the liver to release stored glucose when the body’s glucose levels in the blood are low.

Why is it important for people to have emergency glucagon on hand?

It’s important for someone to have glucagon available if they are on medications such as insulin or they take medications called Sulfonylureas (a group of medicines used to treat type 2 diabetes), which cause the pancreas to actually push out more insulin. Because they then have insulin action in the body—either from giving themselves insulin or a pill—they then may have a low glucose level or a hypoglycemic episode. And sometimes our bodies don’t effectively respond to hypoglycemia.

For example, patients with type 1 diabetes may have an impaired ability to release glucagon from the pancreas just like they may not be able to release insulin, or may not be able to produce insulin. So it’s important that they have glucagon, especially if their glucose levels get really low and they’re not able to consume carbohydrates to raise their glucose levels.

I’ve had type 1 diabetes for 24 years. I know I typically have my glucagon shoved away in a drawer somewhere. Why is it important for those of us who have diabetes to make sure the people we’re spending time with also know how to use glucagon?

Typically glucagon is going to be given when you’re not able to give it to yourself.

It’s when you can’t consume carbohydrates, or you may not be alert and oriented. You may actually be unconscious or having a seizure. You can’t actually communicate with the individual who is with you at that time, what they need to do. So that individual is also going to be, shall we say freaked out a bit, because they’re going to be faced with a situation that they are not used to and they don’t want to be in, to be honest.

So get as prepared as you can, make all the individuals around you—whether it’s a roommate or a partner, or by chance your child, if need be, or a coworker—know how to help. It’s important that other people know that you have a means of helping yourself and them helping you.

I think one of the reasons I used to be so worried about showing people is that there used to only be one glucagon option. It was scary. It had a big needle. It was hard to use. I didn’t like it. Now with the new glucagon options available, they’re all really easy to use. So can you take us through the new glucagon options?

There are technically three new options, but there’s really actually five new ways.

One of the ways is a nasal inhaler. It’s a single spray, into one nostril. It doesn’t matter if you have a cold, allergies, it’s absorbed in the capillaries right in your nostril.

The other options do have needles. Some of them happen to be hidden, which is also a benefit. There are two pre-filled syringes and there are two auto injectors, very similar to what more people are aware of—an EpiPen. It’s very similar to that, where literally you just put it up against the skin and press down. They’re very easy to use.

What are some of the times where glucagon might not work the way we think it’s going to work?

Glucagon works by telling your liver to release its stored glucose, raising your blood sugar levels back to safety. But there are times when the liver doesn’t function the way we want it to.

One situation might be when somebody’s had a few drinks. And if you’ve had a few drinks, your liver has had a few drinks. So think about the fact that your liver is slowed down and may be sluggish to respond. And therefore it isn’t going to respond in the urgency that we want it to respond.

Another situation is actually after intense exercise, because you may have used up your stores of glucose and not have any left to use. That’s why it’s actually important to make sure you actually replace your stores by having a snack or a sports drink. If you have a low after exercise, you may not actually be able to use glucagon to respond. You may need to actually call emergency services and get some glucose injected, rather than glucagon.

Older adults also don’t tend to have as much stored glucose in their livers. So they might not respond to the same extent. And they may also not be able to a sense their glucose is low, either because of medications that they take that can change their ability to sense their glucose levels.

I’ve actually had students of mine describe situations where they were working in a pharmacy, and they thought that somebody came in and they were drunk, but they actually were having a hypoglycemic episode. And luckily, the pharmacist noticed that they were somebody that was on insulin and checked their glucose level, and was able to help the patient. So it is also something that might be confused with actually, somebody acting as if they’re intoxicated.

Are there different things people need to be aware that might happen after someone gets a glucagon injection or nasal spray?

One thing that’s important to note is glucagon can cause nausea. It’s the top adverse effect for every single one of these new formulations and old formulations. It’s recommended to give glucagon when the person is laying down. Well, if they get nauseous or if they vomit and they’re laying on their back, they actually may breathe that in and choke.

So you want to make sure, just in case—not that I want anybody to vomit, but just in case—that they are laying on their side.

So to recap—we need to make sure we know that glucagon might act a little bit differently if we’re of older age, if we’ve just exercised, or if we’ve consumed a few drinks. And we need to make sure that the people around us know where we’re keeping our glucagon, how to use it, however way we want to explain that to them, and to turn us over on our sides, if they’ve administered it. 

Exactly.

The last thing I wanted to cover is the cost. What’s the best thing for people to do if they’re wondering about cost or think they might need some help with the cost of glucagon?

I would suggest that they look at the different websites for the different companies that make the different products. Often you can see the different support options [like copay cards or Patient Assistance Programs (PAPs)]. Some people may qualify for some and not for others. If you have questions, you can even ask your pharmacist—they might be able to help you navigate those different options. But that would be the first step, would be to go to those websites, because they’ve made them much easier to navigate and show you what you might or might not qualify for.

That’s so good to know. Are there any last things that you want to make sure people are thinking about in terms of glucagon?

Even if you’ve never had a low, really consider having a glucagon kit. You want to be prepared just in case.


This educational content about glucagon is made possible with support from Zealand, makers of ZEGALOGUE® glucagon. Beyond Type 1 maintains full editorial control of all content published on our platforms.

WRITTEN BY Lala Jackson, POSTED 02/17/22, UPDATED 03/15/22

Lala is a communications strategist who has lived with type 1 diabetes since 1997. She worked across med-tech, business incubation, library tech, and wellness before landing in the T1D non-profit space in 2016. A bit of a nomad, she grew up primarily bouncing between Hawaii and Washington state and graduated from the University of Miami. You can usually find her reading, preferably on a beach.