I may have answered my own question. Glucagon is injected sub-q, so much like insulin there is a delay due to adsorption. Mayo Clinic indicates usual action time is 10min. That’s about the same as I experience taking glucose tablets on an empty stomach. With that in mind glucagon would probably be faster than oral glucose on anything other than an empty stomach, but a 10min feedback loop is still slower than I would like. Not worth the bother. Injecting IM would speed things up, but I can do without the pain.
Nasal glucagon is likely faster, but I can’t imagine there’s a way to microdose with the currently available products.
In Canada, at least in my area, mini-dose glucagon has been recommended off-label at least as far back as my childhood (~25-30 years ago). It’s not “officially” approved by Health Canada, but I’ve been to numerous diabetes clinics where it’s been brought up by the CDE as a legitimate option. It seems people in the US are much more suspicious about mini-dosing glucagon, which makes me think it’s probably never recommended by medical professionals there.
Mini-dose glucagon as it’s recommended today isn’t meant to treat routine lows. It’s meant to treat lows that are not yet severe but where the person can’t eat or drink for various reasons and things are likely to progress to a severe level in the near future. The most common being a stomach bug where they can’t keep anything down and blood sugar is dropping. In that case, using mini-dose glucagon can be the difference between visiting emergency for an IV or staying home. But someone may also refuse to eat or be unable to eat for other reasons. In my case, due to other medical conditions I’ve had instances where I’ve bolused for a meal and then had my jaw lock open or esophagus swell shut, but of which caused me to be totally unable to eat or drink. A mini-dose glucagon option could have been useful in those situations.
I think having an auto-injector form of glucagon will be very helpful for emergencies. Due to other medical conditions, if I ever need to take my EpiPen, I also need to take glucagon. So being able to tell people to just inject me with both in the case of an emergency, or even just knowing that someone else could use the glucagon during a severe low, will be useful. As it is now, I carry my glucagon kit everywhere, but I don’t realistically expect anyone other than me could administer it. Hopefully this will come to Canada soon.
This company is working on a pen specifically for mini-dosing (that I think will probably function much like an insulin pen, probably using the same screw-on pen tip needles). I think at that point, it will be available to use more for more routine lows. I don’t think I’d use it for every low, but I’ve had some lows overnight that have lasted for literally hours. I would much prefer taking a shot that resolves that type of low then stay up half the night eating. And, although treating a single low doesn’t take many calories, I have lows most days of the week and often have multiple lows in one day, and that does add up over time. As someone trying unsuccessfully to lose weight, I think being able to cut out what adds up to thousands of extra calories each year could be really helpful.
The banana or a few Skittles don’t add up to many calories in one instance but doing that on a regular basis can add up. If one consumes on average three glucose tablets or food-equivalent per day, that adds up to 45 extra calories per day.
In a year that’s 45 x 365 or 16,425 extra calories/year. That’s about an extra four pounds of weight gain. I know from the times I gained weight, it was a low and steady gain, like 20 pounds over 10 years. I don’t think the concern about extra calories we consume treating hypos is trivial or misleading.
I don’t really care if it’s slightly faster. My bg’s come up quickly enough if I eat the correct thing. I’m concerned if mini dosing some expensive med is going to be a few minutes faster–who cares??
I specifically got a prescription for anti-nausea pills for this exact case. I rarely get sick enough to even think of this, but when I get really sick, this is a serious concern for me!
Some people may be missing the point here on why the shelf-stable stuff is so much better.
How many on this thread have actually taken glucagon?
You don’t usually need the full 1 ml dose that comes with the normal kits. Usually that amount would spike the crap out of you. Even when I am super low, only 25 units is enough to bring me back.
So the advantage of the shelf-stable stuff is not only the ability to micro-dose, but if you need it for a severe low treatment, you don’t have to ditch the rest of it. Out of a single prescription quantity (1 ml), you can get 3 or 4 treatments for a severe low.
With the old (non shelf-stable) glucagon, after you use it, you have toss the rest after a few days because it deteriorates.
So the new stuff - allowing multiple treatments for a severe low - would actually be cheaper than having to get 3 or 4 complete glucagon kits of the old stuff.
And THAT is the point of it - that you don’t have to use the whole thing or toss it. Why else would they make it shelf-stable?
The micro-dosing is an added benefit, but it does not have to be the only reason to like this new stuff.
Well, I totally agree with you for your use of it for severe low treatment. b
But they DID also make it to micro-bolus for the new dual pump setups coming out in the future.
Back in the 80’s I used it 4 times. Once was when my bg’s were right near zero thanks to an accidental 20+ unit injection of combined long & quick acting insulins that hit a vein. Since I got a pump in 1996, I’ve not used glucagon again.
If someone has several severe lows are you saying that they can get 3-4 treatments out of one vial? I would think that how many treatments a vial could handle really depends on the circumstances and depth of the lows.
With the current glucagon kits, they are 1 ml. For severe lows, 25 units (0.25 ml) brings me up about 100 BG points. I have never been in a situation where 100 points was not enough…
If my liver is not fully stocked, then I get slightly less of a bump, but 25 units is still enough.
So if the new stuff is sold as 1 ml, I would expect I could get 4 doses out of it.
I’ve never given it to myself, but I’m sure it was used on me once in the late 80’s when I ended up in the ER with a hypoglycemia-induced seizure. I sure don’t miss NPH!!!
Can you say more about your mini-dosing experiments?
Sure. I used an emergency old-style glucagon kit and dissolved the powder in the small vial with the liquid in the big syringe. I then used an insulin syringe to draw up about 15 units and injected that. I found that this size dose nicely raised my low blood sugar.
I can’t say exactly how high my blood glucose went as I didn’t keep records but @Eric2’s claim using 25 units and seeing a 100 mg/dL rise seems consistent with my memory.
What’s interesting is that all adults have about the same storage capacity for liver glycogen. The liver can generally store about 100 grams of glucose. A little more or less, but everyone is in that same general ballpark.
You may have much less available depending on diet and activity, but I am referring to the total size of the tank, not how much gas is in it at any given time.
So if their liver is fully stocked, I expect most people would have a tremendous spike from a full dose of glucagon.
I was in elementary school and after a few times where they gave me the full dose of the glucagon syringe, my parents figured out that they could cut the dose down a whole lot and it would still be enough. I am not sure, but they might have been some of the first people to do off-label glucagon dosing. This was before the internet, so they just had to figure stuff out by themselves.
My mom always gave half doses when I was a kid even when I was having diabetic seizures. I have had so many doses of glucagon over the years that I probably couldn’t count them all. I wasn’t ever nauseous from it either. A pen where you can dial the dose in would be extremely useful for children as the full dose is way to much for kids. I’m sure my BG was sky high after being injected with glucagon even with just half doses.
From the article: “Both options will be available in two doses: a 0.5 mg/0.1 mL dose for pediatric patients and a 1 mg/0.2 mL dose for adolescents and adults.”
That’s good but I was always given a half dose and it still shot me way too high. A quarter dose or even less would have made for a much smoother landing. Dialing the dose in just like a insulin pen according to weight/BG level would be ideal IMO.
I think the key thing with this particular type of product (autoinjector) is that it’s meant to be usable by people who have never used a syringe or done and injection before. So they want it to have as few steps as possible. Pull off the safety and slam it into the person’s thigh, if it’s like the EpiPen. That’s it. Even someone with 30 seconds of training who is panicking as their child/student/friend/colleague has a seizure can probably still do that effectively. Though there have been studies that have shown that people use an EpiPen wrong when given no training and in a non-emergency situation. So they really need to make these emergency devices as simple and foolproof as possible. Having to dial up a dose or push down a plunger would make this device no longer be an autoinjector. It does sound like maybe having half the dose overall would be helpful, but maybe there’s some reason they settled on 1.0 and 0.5 as the doses, like maybe there are people for whom the smaller dose isn’t enough for some reason.
