I'm struggling to understand the low bar for success for Dasiglucagon

[Jen]

@Tim12

I’m amazed that the convenience is worth a 30 times increase in price.

I can’t speak too much to the price issues in the US, since I don’t live there. In other countries, epinephrine autoinjectors and glucagon kits cost about the same. And in most countries other than the US, these things cost significantly less (including epinephrine autoinjector brands like Emerade and Jext that aren’t available in the US). Also, the EpiPen is not the only autoinjector available in the US, it’s just the most well-known and the most expensive. Other brands, such as Auvi-Q and Adrenaclick, are considerably cheaper from what I understand.

The convenience of an autoinjector is probably worth it for anyone who lives alone, travels a lot, or works in a changing environment. I have a glucagon kit, but at the moment it’s useless to me for severe lows, because I can’t mix it up and administer it myself during a severe low and I wouldn’t expect colleagues (most of whom I don’t see every day) at work or strangers if I was travelling to know how to use it. The EpiPen, on the other hand (which I carry), is something I’d be able to administer myself during a severe allergic reaction or hand to a colleague or even a complete stranger and have a pretty good chance that they’d know what it is and how to use it.

Epinephrine used to be available in kits with prefilled syringes (which looked very similar to today’s glucagon kits) alongside various brands of autoinjectors in the '80s and '90s. There are companies working on nasal and inhaled version of epinephrine. However, unlike glucagon, if someone self-carries epinephrine and needs it, I can’t think of a situation where they wouldn’t want the full dose.

@Tim12

On the insulin side of the fence, several newer insulins (like my Tresiba) are available only in pens. No vials.

I think North America is the only place where Tresiba is limited to disposable pens. And I agree with you that that’s annoying, because I hate disposable pens. But Tresiba is produced in 3.0 mL penfills elsewhere, so it would be nice if this came to North America, or at least Canada where reusable pens are more common than disposable ones.

@Tim12

So it’s not obvious that any new product might be available in a wide variety of containers.

A company called Xeris, who has submitted for FDA approval of their autoinjector, is also working on a mini-dose pen and a pump-compatible version of their glucagon. Zealand Pharmaceuticals, the company mentioned in the article linked to in this thread, is also working on both an autoinjector and pump-compatible glucagon. Eli Lily has submitted for FDA approval of nasal glucagon. So I do think there will be multiple methods of delivery in the future.

[Dave44]

@beacher

If a person feels like they’re a few seconds from dying, they may not want to be faced with options and decision-making. Grab and inject would work for me – or for those who have to do it for me.

That is silly! Just inject the whole thing!!! Why are u acting as if the ability to use a partial amount means a big complication and “decision” process must be undertaken to administer a full dosage? What sort of process are you conjuring up in your mind that makes full or partial dosing a difficult, mind-bending issue?

[Tim12]

@Dave44

@beacher

If a person feels like they’re a few seconds from dying, they may not want to be faced with options and decision-making. Grab and inject would work for me – or for those who have to do it for me.

That is silly! Just inject the whole thing!!! Why are u acting as if the ability to use a partial amount means a big complication and “decision” process must be undertaken to administer a full dosage? What sort of process are you conjuring up in your mind that makes full or partial dosing a difficult, mind-bending issue?

Maybe you haven’t been as hypo and confused as many times as me!

If I got “in the practice of” low partial-dose glucagon delivery for minor hypos. And then had a major hypo where my brain was barely working and I really needed the whole dose. I can easily see me (or someone else who is hypo) getting confused as to what to do when the full dose was different than the usual partial dose.

I have had whole-dose glucagon emergency injection and I’m glad it saved my life. But it took me a whole day to bounce back from the super-nausea of that full-dose glucagon. So I see why so many would be interested in a lower dose and why so many are discussing it here.

And in terms of full-dose glucagon, reminds of the first Chris Pine Star Trek movie: FIRE EVERYTHING!!!

[Dave44]

Trust me, I’ve been (in the past) “out of it” as much as a human could be, without being totally unconscious.

[Firenza]

Smaller doses would be really good for children because when I was a kid and needed glucagon my mom had to give me half doses so that I wouldn’t get that full mega dose that would have sent me to the moon. So yes it is absolutely possible to just not give the whole thing but it would be easier if there was no thinking involved in the process just point and shoot.