Use of Glucagon in Patients With Type 1 Diabetes

Haymond, Morey W.; Li, Jingwen; Bispham, Jeoffrey; Hickey, Aileen; McAuliffe-Fogarty, Alicia H.

doi:10.2337/cd18-0028

Cited by 25 publications

(34 citation statements)

References 7 publications

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“…Despite being an important and effective treatment option for severe hypoglycemia, more than a third of adults with type 1 diabetes report that they do not have a current GEK prescription [32]. Glucagon may be underutilized because of perceived difficulties for both preparation (manual drug reconstitution) and administration (dose calibration), by parents and caregivers.…”

Section: Discussionmentioning

confidence: 99%

Human factors studies of a prefilled syringe with stable liquid glucagon in a simulated severe hypoglycemia rescue situation

Newswanger

Prestrelski

Andre

2019

Expert Opinion on Drug Delivery

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Background: Two human factors studies evaluated whether a stable liquid formulation of glucagon in a prefilled syringe (G-PFS) could be safely and effectively administered and evaluated the effectiveness of the product label guide and instructions-for-use (IFU). Research design and methods: In a formative study, 11 participants received orientation with the G-PFS instructional materials and performed a single unaided rescue attempt. In the validation study, 75 adult and adolescent participants received training or familiarized themselves with the G-PFS IFU, Label Guide, and device. All participants returned 1 week later to perform a single unaided rescue attempt of a simulated person with diabetes suffering from an emergency severe hypoglycemic event. Results: The formative study resulted in a 100% success rate across all rescue dose attempts. The validation study resulted in 74/75 (99%) of participants successfully using the G-PFS to administer the full glucagon rescue dose, and validated that intended users could learn from, comprehend, and recall the G-PFS instructions to successfully use the product. Conclusion: The G-PFS provides a familiar, easy-to-use alternative to currently marketed lyophilized glucagon kits for treating severe hypoglycemia. The G-PFS IFU and Label Guide enable even untrained users to successfully administer a full rescue dose of stable liquid glucagon.

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Section: Discussionmentioning

confidence: 99%

Human factors studies of a prefilled syringe with stable liquid glucagon in a simulated severe hypoglycemia rescue situation

Newswanger

Prestrelski

Andre

2019

Expert Opinion on Drug Delivery

View full text Add to dashboard Cite

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“…Until recently, glucagon was only available in a dry powder, requiring reconstitution before administration because glucagon rapidly forms amyloid fibrils at acidic pH and degrades by deamination 29 . The reconstitution is a barrier to glucagon prescribing and usage due to multiple steps for injection 30 . The glucagon emergency kits contain a vial of powdered glucagon, and a syringe prefilled with diluent, and instructions for reconstitution and administration 31,32 .…”

Section: Methodsmentioning

confidence: 99%

“…29 The reconstitution is a barrier to glucagon prescribing and usage due to multiple steps for injection. 30 The glucagon emergency kits contain a vial of powdered glucagon, and a syringe prefilled with diluent, and instructions for reconstitution and administration. 31,32 There are 12 key points to note for proper drug preparation and administration that can take several minutes to perform (Table 3).…”

Section: Barriers To Glucagon Treatmentmentioning

confidence: 99%

Glucagon: Its evolving role in the management of hypoglycemia

et al. 2021

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More than 10% of the United States population has diabetes, characterized by hyperglycemia. Insulin and other agents used to treat diabetes predispose people to hypoglycemia, which can be life threatening. Glucagon is an emergency medication that can save lives by quickly raising glucose in people who are unconscious or unable to consume glucose due to severe hypoglycemia. Although glucagon has been commercially available since 1960, earlier formulations required reconstitution of a dry powder with diluent immediately prior to injection, due to lack of long-term stability once reconstituted. Glucagon has been underutilized due to the lack of confidence or ability to administer in emergency situations. More recently, new formulations including a nasal powder glucagon and liquid-stable glucagon have become available. This article discusses the evidence surrounding new glucagon formulations compared with the original glucagon emergency kit including ease of use, efficacy, and safety with a focus on important patient counseling points and relevant clinical information on hypoglycemia.

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“…In individuals with diabetes mellitus type 1 (DM1), the alpha cells' responsiveness to declining blood glucose concentrations is usually diminished. Consequently, they are susceptible to hypoglycaemia [4][5][6], which constitutes an important factor hampering optimal glycaemic control in insulin-treated patients with DM1 [5,7].…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of Intraperitoneally Delivered Glucagon in Pigs: A Hypothesis of First Pass Metabolism

Teigen

Åm

Carlsen

et al. 2021

Eur J Drug Metab Pharmacokinet

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Background and Objective Artificial pancreases administering low-dose glucagon in addition to insulin have the scope to improve glucose control in patients with diabetes mellitus type 1. If such a device were to deliver both hormones intraperitoneally, it would mimic normal physiology, which may be beneficial. However, the pharmacokinetic properties of glucagon after intraperitoneal administration are not well known. Hence, the current study aims to evaluate the relationship between the amount of intraperitoneally delivered glucagon and pharmacokinetic variables in a pig model. Methods Pharmacokinetic data was retrieved from experiments on 19 anaesthetised pigs and analysed post hoc. The animals received a single intraperitoneal bolus of glucagon ranging from 0.30 to 4.46 µg/kg. Plasma glucagon was measured every 2-10 min for 50 min. Results Peak plasma concentration and area under the time-plasma concentration curve of glucagon correlated positively with the administered dose, and larger boluses provided a relatively greater increase. The mean (standard deviation) time to maximum glucagon concentration in plasma was 11 (5) min, and the mean elimination half-life of glucagon in plasma was 19 (7) min. Conclusions Maximum plasma concentration and area under the time-plasma concentration curve of glucagon increase nonlinearly in relation to the intraperitoneally administered glucagon dose. We hypothesise that the results are compatible with a satiable first-pass metabolism in the liver. Time to maximum glucagon concentration in plasma and the elimination half-life of glucagon in plasma seem independent of the drug dose.

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Use of Glucagon in Patients With Type 1 Diabetes

Cited by 25 publications

References 7 publications

Human factors studies of a prefilled syringe with stable liquid glucagon in a simulated severe hypoglycemia rescue situation

Human factors studies of a prefilled syringe with stable liquid glucagon in a simulated severe hypoglycemia rescue situation

Glucagon: Its evolving role in the management of hypoglycemia

Pharmacokinetics of Intraperitoneally Delivered Glucagon in Pigs: A Hypothesis of First Pass Metabolism

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