FUDiabetes

New Glucagon advancements

The “mini-dose” glucagon pen sounds nice.

The Forgotten Stepchild of Diabetes Hormones - Glucagon

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Indeed, that would be very nice to have. I hope that it works quicker than glucose tabs. That would be particularly nice for ‘severe’ hypos that just feel nasty and need to be solved as quickly as possible. Precise dosage of glucagon with a pen might also help to prevent hypers after a hypo.
Xeris was developing such a pen, but these days I can’t find much info on that on their website. This is the only statement I could find: “Through a series of grant-supported collaborations, Xeris is exploring additional uses for ready-to-use glucagon in mild-to-moderate hypoglycemia.”


Xeris Pipeline:

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Believe it or not, I’d much rather get up in the middle of the night and take a quick shot than get up and eat food. LOL. Plus, hoping it would help me lose weight. :slight_smile:

I’m looking really forward to a mini-dose pen as well as better rescue method (autoinjector or nasal spray).

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There is a real threat of Liam having tooth and/or health issues related to the sugar he intakes for lows and this would eleviate that concern that we have. Right now, during the nights, when he’s low…he gets some form of treatment. Usually, it’s smarties, but it could be juice, glucose tabs, or something else that’s not great for his teeth. Since he’s sleeping, he doesn’t get his teeth brushed for every snack he has to eat to stave off the lows.

If I had an option of giving an easy, micro-dose glucogon shot (NOT in it’s current form where it basically has to be used immediately or wasted…the new technologies are LIQUID ONLY, and would have a much longer shelf-life), I would certainly do this insted of the current method.

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I dunno. I’ve been treating middle-of-the-night lows with sugar for the past nearly 28 years and have only three small fillings, none of which are fillings that needed any drilling. This despite the fact that I probably ate more sugar than my siblings in the form of low treatments growing up. Yet they had cavities at every appointment, and I didn’t get my first cavity until I was about 25. I know different people have different saliva composition and the like, and so maybe some people are more prone to cavities with sugar exposure than others.

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Here’s hoping!

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I always used to use orange juice; a combination of fructose (just and good as glucose) and acid. The acid etches your teeth so the bacteria have a good substrate to attach to and the glucose feeds them. All the same I haven’t had fillings in years, but I did have a lot when I was young.

I still favor glucose tablets. Yes, in principle they can feed bacteria on our teeth, particularly when we are young, but glucose isn’t as sweet as fructose; it’s less easy to get a sweet tooth from it. It’s also pure glucose, 3g/tablet, and it doesn’t stick to your teeth, unlike candies.

Walgreens and others sell tubes of glucose gel, 15g in a tube, reusable. I carry these when diving because they’re waterproof and it’s easier to suck on a tube underwater than manage a tablet. I’ve never had to use one though and I suspect they are sticky and therefore very tooth decaying. That said the gel can be squirted into the mouth of an incapacitated T1D where they are much more difficult to spit out. Hypoglycaemic T1Ds are so unreasonable.

My experiences with my own glucagon response (I think two extreme, incapacitating, ones in my life) indicate to me that I don’t ever want to inject the stuff. Of course it wouldn’t be me doing it so I wouldn’t get a choice :wink: I get bad highs even if I let my BG get to the level where the response starts to kick in significantly; a glucose tablet or two results in a less bad high, if it even results in a high.

All the same I’ve got a prescription for a glucagon kit; the SCUBA guidelines say to have one and my previous one expired. It’s just something I would never use myself. One of the missing things is the same kit but with saline (like, salt in the vial and water in the syringe) so that my wife can practice. I simply can’t imagine her managing to put together the two components and then give me an injection on a rocking boat without practice.

I got her to watch the video; more appropriate for Friends-Of-Diabetics than diabetics. Since we have an expired kit she will practice (on something like pork) when I’ve filled the prescription.

One related thing I read recently (sorry, I can’t recall the link, probably the Beeb) was that an early treatment consisted of a mixture of insulin and glucagon. This would make sense for anyone without a pancreas, since the alpha cells are gone too, but doesn’t make much sense for a T1D with functioning alpha cells.

John Bowler

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Just the word glucagon makes me want to barf. When I was younger I passed out maybe once or a year I would come out of the ice cold black abyss and shortly after puke my guts outs from the glucagon with a brain ache like no other. Some times people don’t want to eat as well when they’re low and if a family member or someone is dealing with that, maybe this is a option… of course a family member with a needle against a non compliant diabetic… sounds like fun.

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@jbowler and @SFBob, I think both of you are talking about full dose glucagon. In which case, I agree, the current kit is way too hard to use and not something someone would typically administer on themselves.

This post is about mini-dose glucagon, which is administering glucagon in much smaller doses. Using the current glucagon kits that are available today, someone using mini-dose glucagon on themselves may use an insulin syringe to draw up 15 units (or less for a child). This is something that can be very helpful in treating lows, especially if someone can’t eat for whatever reason.

And, in addition to this mini-dose pen, companies are also working on a better rescue pen. One that a family member or friend would be able to use in only a couple of step, similar to epinephrine autoinjectors that are available for severe allergies (of which the best known is the EpiPen). These would be much easier to administer in the rare instance someone may be unconscious or having a seizure from a low.

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Yeah, one has to watch the video in it’s entirity to understand why we’re so excited. :slight_smile:

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According to our resident dentist, simply swishing with water should do the trick.

Like @Jen, I treated lows with table sugar, oj, or Coke for close to three decades, without brushing my teeth or rinsing my mouth after. At the age of 58, I have three fillings.

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When he’s sleeping, he can’t do this. I wish he could, though!

The good news from others who have lived with diabetes for decades gives me a better feeling about this, though!

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If it makes you feel any better, I don’t have T1, I have had a mouth full of fillings, and the reason I got so many was soda, both regular and diet - the acid caused them, and as soon as I quit drinking soda I quit getting cavities filled at every visit. And I have brushed twice a day religiously my entire life.

EH, on the other hand, never drank soda as a kid, rarely drinks it as an adult, and now consumes a ton of juice and candy and sugar due to lows and he has zero cavities!

Not that an adult onset data point helps…but now you know.

It certainly seems like having mini glucagon would be rad. Specifically for those persistent drifting lows that you have to take a ton of sugar over the course of an afternoon or evening to correct.

Also, I appreciated reading about people’s experience with the full glucagon shot, because I didn’t know that it caused nausea and headaches. A pharmacist and I walked through the instructions together once, and it seems manageable but not straightforward. Hopefully the mini glucagon design will be more user friendly.

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Because of the nausea, it is recommended to put someone on their side after injecting glucagon to prevent choking in case he/she vomits.
Nausea is probably not an issue with small doses of glucagon. I think these side effects only occur because 1 unit of glucagon is such a large dose. I haven’t heard of problems with glucagon side effects in trials with bihormonal artificial pancreases.

Not specific to any individual here, but as a general rule for the entire D population, the biggest concern I have with glucagon treatments is that people may not be aware of the amount of liver glycogen they have available.

If you eat regularly and use glucagon sparingly or only in more severe situations, it should not be a problem.

But if you ever reach a point where your liver is totally depleted, glucagon won’t do a thing for you.

That’s why a lot of the EMT’s don’t use glucagon, they treat with intravenous dextrose. Because they have no idea what your liver has left!

I have noticed big differences in glucagon, based on how depleted I was. As a test, one time I took an entire 100 units during a long run (not all at once, just bit by bit), and it didn’t do a thing for me. So I took glucagon off my list of potential treatment options for running.

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How did you get a 100 units? A hypokit contains only 1 unit.

Not sure if there is an international difference in terms, or whatnot. But syringes for U-100 are 100 units per 1 milliliter. So when I said 100 units, that is the same as 1 milliliter.

I was using a U-100 syringe, so I ended up giving 100 units, which was the full dose of the glucagon kit, 1 milliliter.

(I did not use the syringe that comes with the kit, because it does not have specific markings on it!! It is only marked 0.5 ml and 1.0 ml.)

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OK, now I understand. I was confused because hypokits contain 1 mg of glucagon, which is 1 international unit. But you’re using an insulin syringe for glucagon, so the units don’t correspond. There’s a 100-fold difference, if you used 1 ml of the diluent.

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FDA has now approved Baqsimi which is a nasal powder (no mixing required, and no needles). This is “Lilly’s nasal spray” that’s mentioned in the video! Hopefully some of the other advancements mentioned get approval soon as well

https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-severe-hypoglycemia-can-be-administered-without-injection

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I would like to see nasal spray in addition to this since it can be used for someone who is unconscious. If you aren’t to that point yet the powder would be great also. I just wonder what health issues long term use may cause to the nasal cavity, brain, etc.