For my fellow Canadians. Great news Baqsimi is now in Canada. It is a nasal glucagon spray! I have not had to use glucosamine injections on my son but I could only image how stressful the situation would be nevermind all the steps to prepare the injection. The spray was partially covered by our medical. I think the pharmacy said it is $100 without insurance. The school loves it too!
Thanks - that sounds like a good thing for my son at school. I will have to read up on it. I have experience using the injectable glucagon and have no problem using it but it is a bit of a faff to mix and inject. I can see a caregiver who does not have experience with injections liking the nasal spray because it is easier to administer.
Link for those interested.
For school use, Baqsimi is a good option.
But the problem with Baqsimi for home use is that I don’t think it has any dosing options. It’s pretty much a one-size-fits-all dose. And the big spike that happens after a full glucagon dose can be a pain to deal with.
For home use, a better option might be the pre-mixed glucagon. This pen comes in two different doses for adults and kids.
And there is no mixing, it’s very easy. Check it out.
How much does Gvoke cost? How much G is “usually” secreted by the pancreas (I’m thinking a very conservative DIY bi-hormonal system here). Numbers I found quickly Googling are a half-life of 3-6 min and a range of 100-400 pg/mL .
That might - if my envelope calculation is right, which it probably isn’t - be about 36 micro-grams .
 =(360* (250*(10^-12)*400))*1000000 - 360 half-lives in a day, 4L blood
I imagine the cost depends on insurance coverage and so forth.
The though of a DIY bi-hormonal system is awesome! I love that. I can donate some glucagon to you if you want to give it a go. Within the coming week I should (hopefully) be able to land a good bit of it.
I have been wanting to do that, just have not gotten around to it yet, because my liver is frequently depleted. But the idea is intriguing. I have a few PDM’s (I use OmniPod). So it would be trivial to fill one with insulin and the other with glucagon, and see how it works.
Tell me more about your idea.
Also, the amount a person secretes varies on a bunch of things. But I found about a 20 point rise per 5 units (very roughly).
Note that this liquid glucagon isn’t available in Canada. I’ve heard no news on whether they’ve applied for Health Canada approval.
I just got a prescription for the nasal glucagon. It’s not covered by anyone yet, so I’m holding off on filling it. My doctor said it costs about $10 more than the current kits.
There is apparently a bi-hormonal product called iLet (https://www.drugdeliverybusiness.com/beta-bionics-starts-new-trial-for-bionic-pancreas/) that is being developed independently of “the big guys”.
My endo said the creator Ed Damiano had a “falling out” negotiating with Dexcom/Insulet/Minimed people - no details. I wonder if the “big guys” wanted to basically go slowly with single-hormone systems and “dribble out” more funcitonality - and Damiano wants to just get it out there as fast as possible.
With my own DIY idea, I was going to start with a separate app that would simply pair with a separate Omnipod, and deliver a set glucagon bolus every 3-6 minutes to start with. But looking through the RileyLink/Loop code, it said that a lot of the code is not thread-safe - I don’t know how that would play with having separate instances of the application.
Then I’d move on to increasing and decreasing doses (though getting it so that it didn’t run out of control might or not be tricky), or temporarily adjusting the amplitude or phase of the pulses for trying to “prepare” the body for exercise, waking up, etc.
Hi Jen- our nasal glucagon was mostly covered by Sunlife extended health in BC. We go through Walmart pharmacy. I can’t remember how much was covered but at least 75%
@Eric > because my liver is frequently depleted
I personally wonder if how “depleted” the liver is depends on glucagon. If the presence of glucagon sensitizes the liver to insulin, so it absorbs glucose, which the glucagon then signals it to release later on), and/or stimulates the liver to expand it’s capacity, and/or increases the regenerative capacity of the liver, or increases cell turnover (hepatocytes) - to “keep the liver fresh” so to speak.
This would have a prediction that if there might be a subgroup of Type 1 or 2 that has low glucagon where the “liver risk” might go up. How you’d measure that - I have no idea. My endo said that in diabetes (both types), glucagon "usually goes up - because there is less insulin. But I have no idea whether he’s read primary/secondary research actually confirming that it actually happens (*).
Even if it does happen in a cell culture, that doesn’t necessarily mean that it happens in an actual pancreas. There are at least 3 kinds of non-alpha/beta cells in the islets. There may be other sources of insulin and/or glucagon - I read one article abstract that suggested the question of whether the brain make it’s own insulin is still open (though if it does because insulin doesn’t cross the BBB, it might not reach the pancreas for the same reason).
The pancreas also probably responds to other hormones from all sorts of places (at least digestive, other endocrine organs, brain, and probably immune systems). And I read that the islets are electrically active. Whether this means there is intra-islet coordination (like heart muscle), I don’t know.
(*) Or a primary source followed by secondary that confirms it’s not just a “one-patient/cell-culture fluke”)