Derek is an outdoor person. He spends much of his time in Macomb, MI, camping, hiking, fishing, and hunting, often with his sons, one of whom has type 1 diabetes (T1D)—just like Derek.
A few years ago, while his sons were visiting, Derek was treating a low blood sugar with a few chocolate chip cookies. The next thing he remembers is waking up next to a jar of honey, an empty bottle of apple juice, and two used glucagon kits. He was disoriented…and surprised.
“I’ve always been able to treat lows without any problems, but that one got away from me,” he said.
Fortunately, he had glucagon nearby and his wife knew how, and when, to administer it.
“She gave me one shot of glucagon but my son, a state police officer, still couldn’t get me to respond,” Derek said. “So, she gave me a second shot. A few minutes later, I came around, but I felt like I had gone a few rounds in the ring with Muhammad Ali.”
The episode left them both shaken.
“My wife said to never let that happen again and I understood her feelings completely,” he said.
Glucagon to the Rescue
Glucagon. It’s a word familiar to people with T1D, yet one most hope to avoid discussing. But what is glucagon and what is its role in the management of T1D?
Glucagon is a hormone released by the pancreas that works in tandem with insulin to keep blood sugar levels in healthy ranges. In people without T1D, the two hormones are being released all the time–insulin to prevent blood sugar levels from rising too high, and glucagon to prevent it from going too low.
But for people with T1D, a drop in blood sugar often doesn’t trigger a normal glucagon response and blood sugar can continue to drop, occasionally resulting in severe hypoglycemia (less than 55 mg/dL or 3 mmol/L).
Signs that a person with T1D is experiencing a severe low blood sugar episode include:
Having difficulty walking or seeing clearly
Acting strange or getting disoriented
Fainting or passing out
Glucagon is used as a rescue medication, in injectable or nasal spray forms, to treat episodes of severe low blood sugar when someone is unable or unwilling to ingest carbohydrates safely, or if they are unresponsive. It typically helps bring blood glucose levels back up into a safe range (over 70mg/dL).
Coleen cares for her teenaged grandson with T1D in San Diego, CA. He recently went to a party with friends and came home sick, with vomiting and severe lows. She was monitoring his blood sugar on his continuous glucose monitor (CGM), watching his number dip into the 40s, and forcing him to drink soda with no improvement. “At some point, I decided to use Baqsimi nasal spray,” she said. “It took about 15-20 minutes to bring him up, but I knew he was going to be okay.”
That event, while frightening, was a “teaching moment” for Coleen and her grandson. Now, his best friends are all trained in how to use Baqsimi in case of emergency.
The Different Forms of Glucagon
We all know that T1D care is not “one size fits all.” Personal preference and insurance coverage (or lack thereof) all impact how people manage their disease. Glucagon comes in several forms, which gives people with T1D options to choose from based on those factors:
Baqsimi is a dry nasal spray administered in one nostril. Because there is no needle involved, it tends to be a bit less intimidating for caregivers to administer. The most common side effects after use are mild and include nausea, headache, and discomfort in your nose.
The GvokeHypoPen is available as a pre-mixed autoinjector or a pre-filled syringe (PFS). It is injected into the upper arm, stomach, or thigh. Both come in a convenient two-pack and are available in two premeasured doses: one for kids (under 100 lbs.) and one for adolescents and adults. The most common side effects after administration are mild and include nausea, vomiting, swelling at the injection site, and headache.
Zegalogue comes in a pre-filled syringe (PFS) or an autoinjector pen—no mixing is necessary. It is injected into the upper arms, lower abdomen, front or back of thighs, or buttocks. The most common side effects after administration are mild and include nausea, vomiting, headache, diarrhea, and injection site pain.
In all cases, after Glucagon is administered the person must be turned on their side in case of vomiting and 911 (or emergency medical help) should be called immediately.
I Have a CGM, I Don’t Need Glucagon!
With the increase in use of CGMs and artificial pancreas (AP) systems, the risk of severe hypoglycemia is reduced for many people with T1D, so carrying glucagon may not be as much of a concern. For Coleen, while her grandson’s CGM has been “lifesaving” on many occasions, it doesn’t preclude the “what ifs” or the unpredictability of the disease.
“That night, if he had slept over at a friend’s house, he may not have woken up,” she says. “He carries Baqsimi with him all the time now.”
Availability and Affordability
Glucagon is considered an essential part of a T1D’s supply kit, yet a recent study shows that only 47% of T1D caregivers carry a form of glucagon with them at all times. For adults with T1D, that number is even lower, a troubling 29%. In contrast, almost 60% of people who need an epi-pen, another lifesaving rescue medication, always have it with them.
So why is glucagon an afterthought for so many people with T1D? The most common concern is cost.
The list price for the various forms of glucagon is around $300 per device, but insured patients can download savings cards that reduce the cost significantly.
JDRF’s Insurance Guide is also a helpful resource for people with T1D to find ways to reduce the financial burden of the disease.
The Life Raft in Your Supply Bag
Having the right tools to manage T1D allows you to take charge of your well-being. Glucagon is like a life raft: you may not use it daily, or even ever, but if there comes a time when you do, you’ll never be without it again.
Despite being diagnosed over 50 years ago, Derek still recognizes the challenges of having T1D, but he doesn’t let bumps in the road stop him from living his life to the fullest. “I control my diabetes so I can do things I enjoy when I want to,” he said. “Sure, T1D gets in the way every once in a while, but it doesn’t control me.”
Editor’s Note: This educational content is made possible with support from Lilly. JDRF produces this content to provide information to our supporters about their potential options for managing their T1D and not as an endorsement of products. Editorial control rests solely with JDRF.