Glucagon Rescue Options for Hypoglycemia

Have you ever told someone, "I don't need to worry about low blood sugars, because my blood sugars are always high?"

As a certified diabetes care and education specialist (CDCES), I hear this from clients often. Usually, people who say this have been on a long road to maintaining controlled blood glucose, so the idea of low blood sugar seems strange. Low blood sugar (hypoglycemia) may feel like a topic that is not worth your time. But, if you take diabetes medicines that can cause hypoglycemia, it's important to understand treatment options.

What is hypoglycemia?

Mild or moderate hypoglycemia is usually treated with food or drink to bring blood sugars back to a healthy range. There are some guidelines to define the different levels of hypoglycemia severity:¹

• Mild – glucose level under 69 mg/dl
• Moderate – glucose level under 55 mg/dl
• Severe – glucose level under 40 mg/dl

In cases of severe hypoglycemia, you will likely need to be treated with a glucagon rescue device.^1,2

What are glucagon rescue devices?

Glucagon rescue devices are used to bring up a low blood sugar level when you can't eat or drink, or are unresponsive due to a low blood sugar level. They deliver glucagon (a hormone) into your body, which causes your liver to respond in ways that raise your blood sugar level.³

Older glucagon devices tended to be much harder to use and required mixing of glucagon powder and saline before giving a dose. One study showed family and friends struggled to use these older devices nearly 70 percent of the time.⁴

Newer glucagon rescue devices have longer shelf lives (they don't expire as quickly) and can be administered in a few simple steps.⁵

Popular glucagon rescue devices

Gvoke HypoPen

Gvoke HypoPen^® is an injection (shot). Gvoke comes in doses of both child and adult size. It is injected into areas of the body with extra fat tissue (usually the thigh, belly, or back of the upper arm). Your friends or family members will not see the needle go into your body with this injection. Instead, they will watch a dosing window to ensure you get the total dose.

Baqsimi

Baqsimi^®is a nasal spray. You do not have to be conscious for the nasal spray to be administered. This means it doesn't need to be inhaled.

It can be stored at higher temperatures if needed. Baqsimi is an excellent glucagon rescue device option if your loved ones are nervous about giving you a shot.

Sharing your diabetes treatment plan

There are essential tips you need to know about glucagon, including:

• When you should ask for a prescription
• What friends and family need to know,
• More layers you can add to your diabetes treatment plan if you struggle with severe lows

Involve friends and family

Friends or family will use glucagon rescue devices to help you recover from low blood sugar. Ensure they know where you keep your glucagon and the warning signs of low blood sugar.

Ensure they can look at the device and review how to use it via the manufacturer's websites (don't break seals on the glucagon packaging until you're ready to use it). Loved ones should also learn how to check your blood glucose on your meter to ensure your levels return to healthy ranges within 10 to 15 minutes.

When in doubt, instruct your loved ones to call emergency services. Family and friends can get overwhelmed or scared if they see you having severe low blood sugar. They should call emergency services if they're confused about using your glucagon rescue device or concerned about your well-being (seizure, difficulty breathing, not responding to glucagon injection, etc.).

Finally, your friends and family need to turn you on your side after treating you with glucagon. You may vomit after getting glucagon, and if you're not alert enough, you might aspirate (breathe vomit into your airway and lungs).⁶

Set reminders

Set a reminder on your phone or calendar, or make it a yearly routine to check your glucagon's expiration date. Friends and family will not likely do this if they're trying to use glucagon in an emergency. Expired glucagon may not work as well, if at all.

Consult your medical team

If you've had severe low glucose or have low blood sugars often, it's a good idea to bring up glucagon with your medical provider. Additionally, there are some cases where glucagon isn't a good fit – if you have allergies to it or any of its ingredients, certain types of tumors, certain health conditions like malnutrition, and more. A discussion with your provider can help you determine if glucagon is safe for you to use.^3,6

Additional tips when dealing with hypoglycemia

If you struggle with low blood sugar, there are additional layers of support I've found helpful for people over the years:

• Wear a medical alert bracelet so others understand how to help if you're experiencing low blood glucose.
• Always pack a glucometer and hypoglycemia treatments with you when traveling.
• Use a continuous glucose monitor (CGM) with alerts. Share your CGM data with trusted family or friends.
• Check blood glucose before driving or operating machinery to reduce the risk of accidents or injuries.
• Treat hypoglycemia right away.

Some people with type 2 diabetes are at risk for severe hypoglycemia. Learning more about treatment options for severe lows can help you better prepare in the event one happens to you. If you struggle with low blood sugars often or with severe lows, reach out to your medical team, since you likely need some adjustments to your diabetes treatment plan.