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Clinician’s Corner: GLUCAGON: THE BASICS

Simply put, glucagon raises blood sugars. Glucagon increases glucose by mobilizing conversion of sugar (glycogen) stored in the liver.

Glucagon is administered for the treatment of severe hypoglycemia, especially for patients unable to swallow. Up until 2019, glucagon could only be administered as an injection that needed reconstituted.  This cumbersome product required diluent placed in a vial of dry powder, swirled, withdrawn into a syringe and injected in the patient.  Think about trying to utilize such a product in the event of an emergency… with your loved one.   July and September 2019 brought diabetics and those of us who care for them some very good news.

Glucagon for Injection (Eli Lilly)  (cost is $300.00)

GlucaGEN hypokit for Injection (NovoNordisk)

Glucagon Emergency kit was approved in September 1998.  The powder in vial needs to be reconstituted and yields a dose (adult) of 1mg SC, IM or IM.  The pediatric dose for a child under 20kg= .5mg

  • Inject glucagon into the individual’s buttock, arm or thigh, following the manufacturer’s instructions.
  • When the individual regains consciousness (usually in 5-15 minutes), they may experience nausea and vomiting.
  • Inform provider about glucagon use to discuss hypoglycemia.

THE NEWEST GLUCAGON PRODUCTS

Baqsimi  ($300.00 per dose)

is a glucagon nasal power dosed at 3mg approved by the FDA in July 2019 and marketed by Eli Lilly. Baqsimi is approved to treat severe hypoglycemia in patients with diabetes 4 and older.

Efficacy:  Baqsimi demonstrated efficacy comparable to injectable to glucagon 1mg injection. 98.9% experienced treatment success versus 100% for glucagon injection.

Adverse effects:  Aside from nausea and vomiting, nasal irritation and redness in the eyes can occur due to route of administration.

Ease of use: Baqsimi is given on one side of the nose.  It does not need to be “snorted”.  It is effective if a patient has nasal congestion due to cold, or if taking cold medicine. Emergency services should be called at once, and after 15 minutes another dose can be given if there is no response.

Gvoke® ($300.00 per dose) by Xeris Pharmaceuticals

was released this month (Sept-2019) and is the first and only premixed, pre-filled, and pre-measured liquid glucagon product, now approved for the treatment of severe hypoglycemic events among adults and pediatrics with diabetes ages two and older. Gvoke is available as a prefilled syringe as well as an autoinjector.

Efficacy: Gvoke® demonstrated its ability to effectively resolve severe hypoglycemia showing 99% of adults and 100% of children achieved treatment success, which occurred in less than 14 minutes.

Packaging: Gvoke® has two pre-measured dosing options: one for adults (1 mg/0.2 mL) and one for children (0.5 mg/0.1 mL), available in one or two-device packages.

Ease of use: In usability studies, 99% of people were able to successfully administer a full dose of Gvoke in a simulated emergency setting

Your Thompson Pharmacist is truly excited about these new forms of glucagon.  As of this posting GVOKE, which was approved last week is not yet available in our warehouse but is expected soon.  Baqsimi is ready and available in our warehouse.  Inform your physician of these products and call your Thompson Pharmacist for anew prescription of these potentially life saving medications, especially if you use insulin. Every Type-1 diabetic should always have a glucagon device available.

Let your Thompson Pharmacist handle all your routine and emergency diabetic needs.  Go AHEAD and ASK, at Thompson Pharmacy it’s ALL for YOU!