OK guys. Got a checkup coming up this week, and I need to ensure my prescriptions are up to date. My glucagon kits are way expired, so I thought I’d update my emergency kits.
My insurer covers 100% of the following: 1) Baqsimi, one or two pack; 2) Glucagon kit; 3) Gvoke hypopens, one or two pack, 4) Gvoke kit 5) Gvoke prefilled syringe 6) Zegalogue auto injector or prefilled syringe
That’s quite a variety! Curious about you guys’ opinion on these. I can see the potential convenience of Baqsimi, inhaled instead of the other injected options. I suspect Glucagon would have the longest shelf life? Gvoke and Zegalogue would be convenient, I guess, no mixing involved.
Glucagon is a dinosaur and more trouble than it’s worth, imo. No one wants to read through mixing instructions if you are having a true emergency. We started out with that and quickly switched to Baqsimi…super simple nasal spray. Open, put into the nostril, squeeze, done. Gvoke is also a good option but it’s a shot and I didn’t want that for @Liam-M given he already has to stick himself more than I like.
Our choice is Baqsimi, hands down. Small and portable and ease of use makes it our choice.
Also after nearly a decade, never had to use any of them. I did use glucagon many years ago when he was sick and chronically low but it didn’t help much…possibly head space and timing.
We’ve only had to use it once (for a low that was getting worse by the minute) but I remembered to tell my husband to start with a quarter of the full dose…and so I only hit 190 after it took effect.
My spouse prefers Baqsimi, easy to administer - right up the nostril, no needles! For ease of use because I have major motor coordination issues when I get low it’s Gvoke for me - stab and push like an EpiPen. I can usually get that done. If I still have some coordination left, I like the old school kit because I can microdose the Glucagon (learned that from you @Eric -thx mucho!) and then I don’t have the huge back end spike
@mike_g Your question makes me harken to when I first got dx’d and the Endo I saw prescribed Baqsimi. She started describing how to use to me, then stopped and said, “Why am I talking to you, if you need this stuff, you’re going to be out of commission!” She turned to my wife and continued describing how to administer (similar to any nose spray, albeit a powder). My point: You may want to ask your significant other, family member, or other person you rely on what they would prefer and ensure they know when and how to use glucagon. I’ve gone as far to brief folks I’ve gone on vacation with how to use Baqsimi, using an old one to demonstrate (note: not a “live” one). If polls are to be believed, the likelihood of need is relatively remote, but the peace of mind that comes from having it available and having people that know how to use it is a good thing.
While I don’t advocate maintaining “expired” drugs, neither do I believe most have been tested for length of efficacy. I keep my Baqsimi script current, keep an up-to-date one in the kit I have (Flexpen, needles, BG meter/strips, and Baqsimi). I maintain and rotate “expired” Baqsimi’s at our small cabin, nightstand next to bed, drug cabinet in kitchen, and both cars (yes, I’m aware of heat and cold concerns).
Gvoke is slower than than the glucagon “kit”. And also, Gvoke does expire. The kits don’t expire! (I know they have an expiration date on them, but they don’t really expire.)
I have never used Baqsimi, so I can’t comment on how quickly it works. You can’t really adjust the doses easily with it, so I think that’s a problem.
I generally have only done the work with the glucagon kit myself when I was not in an emergency condition, like when I was testing stuff out.
In an emergency, if I can work the kit, I can eat. So why not just eat instead?
My wife is the one who does the work with the glucagon kit. She has never had a problem with it.
The issue about mixing or whatever, it depends on if you think you will be doing it yourself or if someone else will be doing it. So it depends on how well that person can deal with an emergency and do what they need to do. (As @TomH mentioned above.) My wife has not had any issues with it.
The big advantage of any of the injectables is that you can take just a portion of it…as long as you don’t get the auto-pen! If you get the auto-pen version of any glucagon, you might as well go with Baqsimi!
My logic for Baqsimi is that I really don’t care about any high bg that may follow a severe low. Insulin will fix that easy enough to where he won’t be high too long. I am thinking more from an ease of use angle in a true emergency that someone else has to utilize because the patient is completely unconscious. I do agree with the micro dosing potential of Glucagon but the one time I did use it, it didn’t really work at all for us.
Speak of the devil, I took Gvoke last night! (I am back on MDI for a few days and I MESSED UP and took 10u of Novolog instead of Tresiba. Given my very low insulin intake these days, 10u was going to hit hard. So I took the Gvoke and ate half of an entire bag (family sized) of freeze dried skittles. Knock on wood, it all worked like a charm. I was FLAT the whole night. I did read, while I was panic googling, that Gvoke only brings you up by 20 points? That didn’t make a ton of sense to me.
I used one of the auto injectors b/c I messed up on my prescription and that’s what they sent. I will get the other ones next time. Also, I wanted to share that a D friend not on this board tried Baqsimi and it flat out didn’t work for her. So, something to consider when stocking up on rescue meds like this.
@Eric Baqsimi is relatively quick, quicker than the old kits. It hits fairly mild at first, then kicks like a mule on the backend with a very fast rise. Usually on a very severe low you need 2 of them
That makes a lot of sense. In a true emergency, ease of use really is the priority—especially if someone else has to step in while the patient is unconscious. A temporary high BG is much easier to deal with afterward than struggling to administer treatment during a severe low.
I agree that micro-dosing glucagon has its benefits in certain situations, but real-world experiences matter too. If it didn’t work well for you when you needed it, that’s a big factor. Baqsimi seems like a solid choice when the goal is fast, simple action in a high-stress situation.
Speak of the devil - I tried micro dosing gvoke for the first time a couple of days ago.
3 units injected into sub q turned a 75 side arrow down to a 117 side arrow up on Dexcom 20 minutes later. 90 minutes later hit 96 steady. I’m on Omnipod 5 so my basal was suspended the entire time. If I was MDI I’m sure I would have needed to eat something.
I’m super impressed with that result. A nice little bump that lasted.
I don’t think she could have misused it, although I am guessing she was standing when using, not flat on the floor, if that counts for anything? She was at her daughter’s swim meet with scary double arrows down and decided to give it a try rather than get all swoony while feeding a low. (She did have to do that anyway). Perhaps it did work to a modest level and she was expecting a bigger bump? But she didn’t see that “emergency effect” I think most of us would expect to see from one of these medications.
Here is one possibility - maybe she did not have much liver glycogen?
Just as a matter of pointing out something that most everyone here already knows, but just in case they don’t - A glucagon injection does not actually give you any glucose. Rather, it tells your liver to release stored glucose (glycogen).
So for example, if your friend had not eaten in a long time and had been very active, or is on a very low carb diet, etc, etc. In situations like that, a full dose of glucagon won’t have as much of an effect as it would on someone who has a full stock of liver glycogen.
Your liver only stores around 100 grams of glucose. And that is used throughout the day for energy. Your liver is also partially depleted in the morning, since you have not been eating while asleep.
Good thoughts, @Eric . And another potential caveat….if the liver were processing alcohol, I believe that takes priority over releasing glycogen. I know that would’ve been the case the one time my better half was looking for the glucagon back in 2020…and couldn’t find it. She fed me smarties until I could see and hear..and think.. again…..I’m blessed every day.