only once they’ve been mixed is my understanding, and that too it’s not a dramatic difference.
Was unsure your meaning but I do not think this is intended to be kept after it is mixed like you would a bottle of insulin?
It does not last long once mixed. But since I have some left, I’ll test it the next few days. 
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That will be interesting to compare the impact when freshly mixed and as it ages.
I feel sorry for your family for this round of testing…
Or are you able to use a small enough dose so it is just basically like carbs without it being a complete wallop to your system?
The instructions say to discard after use if it’s not all used.
yes, it’s not supposed to be kept after mixing, but many of the long-time T1D nurses and doctors at diabetes camp would put the mixed glucagon in the fridge and keep using it as mini-glucagon shots till it stopped working.
It does for fibrils over time; typically by 3 days at room temperature it’s no good. Different studies have looked at how conditions affect the degradation of the mixture, and keeping it cold and changing the pH can help keep it stable longer once it’s mixed.
Wow. That is pretty far off-label for Docs and Nurses to be using it for. And particularly on kids at a camp?
@Thomas, these were T1D nurses and doctors using it on themselves that way At camp they would use it on campers only for 24 hours after mixing I believe. But using mini-glucagon is not really off-label anymore; I mean my endo practice told us about it pretty soon after diagnosis for my son, as an essential sick-day tool.
I also met another person who literally hooked up two pumps to her body and used mixed glucagon to treat her lows. She said it did start losing effectiveness overtime but that she just increased the dose progressively till it was used up. Not recommending this at all, but the point being that people are doing all sorts of stuff.
Big difference between people doing stuff and Doctors and Nurses telling patients to do stuff.
For Example Eric doing his testing on himself is a far cry from my Endo telling me that his experiments are fine for my daughter to be doing. Not even the same ballpark.
Something is either off-label or it is not. Not trying to be a PITA but if you are saying the use of this drug as described is not really off-label anymore, is there any particular FDA approval that would state as such or marketing by the company (which obviously requires the FDA approval)? That is the definition of what is off-label.
The Doctors and Nurses using the mixed Glucagon on campers for 24 hours after mixing it certainly appears to be off-label from what I read of the marketing of the product. My daughter did go to two different Diabetes Camps for a few years. One camp was overnight and one was a daycamp. If anybody had used off-label or experimental procedures or drugs on her without my knowledge or consent then I can guarantee there would have been serious repercussions.
Sorry just realized you were asking if it’s literally off-label, as opposed to more just a figure of speech. Yes it’s still technically off-label but i think it’s misleading to lump anything off-label into the “experimental” category.
Also, this was family camp (for kids + their parents). So ultimately the doctors are encouraging the parents or kids to try this approach but they’re certainly not administering it without consent.If parents don’t want this done then they don’t do it, obviously.
And like I said, this is considered standard sick-day protocol at least at our very highly regarded endo clinic. They have done clinical trials showing that the use of mini-glucagon shots is safe and effective for the treatment of hypoglycemia when people have stomach bugs, and the protocol developed there was putting it into the fridge for 24 hours for use as needed. So it’s not like it’s an untested procedure.
I mean, there are lots of drugs where, for instance, the standard of care in use is not what the FDA originally approved it for. AS an example, the abortion pill was originally approved at much higher doses for administration, but they found it actually increased bleeding relative to a lower dose that was equally effective. The label was never changed, however.
And the infusion sets my son uses are only FDA approved for 48-hours of use even though my endo tells us to use it for 3 days; this is not because there is any reason to think it’s unsafe; simply that they didn’t pay the money to do the clinical trial for it. With his small body size and the limited number of sites on his body, it’s actually worse for his odds of developing lipodistrophy, etc. if he rotates too often.
Dexcom is also only approved for use on the abdomen – and yet most people I know put it other places with equally good, if not better, results. I could go on, but suffice it to say that off-label probably makes up a significant portion of standard of care across all medical specialties.
So I would make a huge distinction between doctors practicing standard of care versus doctors offering only FDA-approved treatments.
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We can leave that at a significant difference of opinion.
It’s been agreed previously that things are really only “off label” because they haven’t gone through significant enough testing by the company in question to have the methods approved for use. The additional cost, FDA approval requirements, etc., for testing all aspects (how much longer is insulin “good” after 28 days? How much colder or hotter can we store X medicine? Etc., etc., There are a lot of ways we can stretch out our medicines and practices to save on cost and that’s a lot of what these forums is about…sharing what may work…what has worked, etc., just in case someone else needs to do it one day. For instance, we all know that the documented “life” of the CGM Sensor is 7 days and we’re supposed to change it out according to the documentation. However, we all know that they last much longer than that…at least twice as long, and some wear them 3 or 4 weeks at a time (we’ve only been able to do 2 at max so far due to loss of communication…large gap in dots on the CGM.)
There are a lot of things about what we do that’s considered “off-label”, but we do them because there’s no harm to doing them, and they save costs.
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Yes, I am doing micro-doses so it doesn’t spike me too much.
It could be used this way, like carbs, but it’s heck-a-bit more expensive than eating a cupcake. 
I used it again today, the vial has been mixed for almost 24 hours and was sitting at room temp the whole time. And it STILL works. No doubt about it, brought me right up.
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That is fine for you all.
As far as I am concerned, “Off Label” has exactly one definition. I don’t enjoy playing word games.
Then I would recommend you not do so! lol. Not even sure what’s meant by this since no one’s playing any word games. Only stating fact. However, if you use a CGM sensor for 8 days, you’re being “off-label”.
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@ClaudnDaye - Understood. Very much appreciate the clarification.
A little update on this. I mixed the expired glucagon 5 days ago. It worked fine then. I tested it a day later, and it still worked.
So 5 days after mixing the glucagon, I did another test today. The same mini-dose I did before, 25 units (just 1/4 of the entire dosage you get in a glucagon kit), and it brought me up 89 points in just 30 minutes. That’s pretty consistent with day 2:
2nd day after mixing:
106 points in 35 minutes
5th day after mixing:
89 points in 30 minutes
Anyway, the point is, glucagon doesn’t seem to expire when the label says, and it works even up to 5 days after mixing. Maybe longer. I have a little left, I will try again in a few days…
Funny to see, no doubt that 5 day old mixture is working: 
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Thanks 
!
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Slightly off topic: does anyone know if insurance (BCBS to be specific) covers glucagon? I am in an advantageous time period to order D supplies right now and will ask my dr to send in a prescription if so. (Clearly the glucagon I have on hand is also expired… thanks, Eric, for experimenting!) Jessica