Glucagon

by Leighann on August 20, 2010

Glucagon

Diabetes Mine has a post about glucagon: Enject’s GlucaPen: Diabetes’ Answer to the EpiPen

We do have several glucagon kits. We keep one in her bag that we carry her supplies and OmniPod PDM around in. Another at home. And one at the school office (though there is no “nurse’s office”).

The issue I have is that when we try to train people, their eyes glaze over. It seems so complex. ESPECIALLY for young kids who only need HALF of the liquid.

Add that to the fact that we’ve never actually used it (knock on wood, I can’t believe I just typed those words, please diabetes gods don’t give us a crazy low) makes it difficult to explain.

I don’t know if in a stressful situation if I, an experienced D-Mom, could remember all the steps, let alone expect someone who is overseeing her at school and doesn’t do the day to day diabetes stuff to remember how to use it.

We NEED glucagon kits that have half the regular dosage for kids. Seriously pharma, I hope you are listening!

I think that for young kids who are in school, there should be glucagon kits (with saline instead of the actual glucagon perhaps) that allow people to learn how to use it properly. (I’ve heard that you can get such a kit from Lilly, though I haven’t tried. 1-800-545-5979)

I would LOVE a glucagon pen and I would LOVE there to be an option of getting it with the appropriate dose.

Here is a video from the dLife YouTube Channel showing how to use a glucagon kit. She seems so calm!

A couple of our glucagon kits just expired so I took one to school to demonstrate to the staff. To tell the truth, I was a little nervous to demonstrate since I haven’t actually done it before. I was surprised at how quickly the powder dissolved. I took a nectarine because we didn’t have any oranges at home. I laughed because I got glucagon all over the principal’s table.

As I explained the circumstances where she might need glucagon (severe low causing seizure or unconsciousness) I saw the momentary look of terror on their faces. I explained that we have not used it and hope not to. But it’s like an insurance policy, you have it on hand and you know how to use it just in case.

I also checked my own blood sugar to show them how it works. Every time I have done this I am surprised at how much the finger prick stings for several minutes. Q rarely complains. As I waited for the number to appear I joked that I hoped it wasn’t too high or too low. It was 110. Phew.

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{ 15 comments… read them below or add one }

1 Scott S August 20, 2010 at 8:08 am

The reality is that a biotech startup based in San Francisco called DiObex was pursuing a low-dose glucagon product, but the firm was unable to raise additional capital, and last April, the angel investors in the firm (which included Domain Associates, Inventages Venture Capital, FirstMark Capital, Sofinnova Ventures and a few smaller firms) decided they could make more money by selling the company’s assets than by developing it within DiObex. Since then, they have yet to find a buyer for the assets, but rest assured that others are investigating this. Specifically, Biodel, Inc. has a version of glucagon in early-phase development that would not require reconstitution (sort of a glucagon analogue if you will), and an Indianapolis-area company run by some former Lilly researchers called Marcadia Biotech signed an exclusive license agreement with Lilly in June 2010 for Marcadia’s short-acting glucagon, which appears to be a glucagon analogue as well. The deal is for that and some related backup compounds. Under the terms of the agreement, Marcadia will continue to oversee development of the compound through regulatory approval in the U.S., while Lilly will be responsible for obtaining regulatory approval in countries outside the U.S. and for commercialization worldwide. Financial terms of the collaboration were not disclosed. This is very early stage (pre-clinical, meaning still in animal studies) and is likely to be a number of years away. However, Biodel’s strategy is more interesting because rather than a new device or a brand new compound, the company seeks to use generally accepted as safe molecules (glucagon), and modify them slightly to improve them. This strategy enables faster approvals from the FDA because they aren’t brand new compounds or devices, which could ultimately prove faster than the Marcadia/Lilly effort, although it appears that Enject is further along in development than is Biodel at present.

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2 Leighann August 20, 2010 at 9:21 am

Thank you so much for the information, Scott. Looks like there are many (better) options on the horizon. Making glucagon a single step process would be a great improvement. And I hear over and over that school staff aren’t allowed to give glucagon, but can do epi pens. We need to get a technology in the hands of caregivers that they are actually “allowed” to use.

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3 Jessica August 20, 2010 at 9:02 am

I would LOVE that. Liam’s preschool technically isn’t allowed to give him an injection of glucagon. They get trainings every year on the epi-pen, and they are allowed to do that.

And I totally know what you mean about the finger pricks stinging. Our kids are tough.

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4 Leighann August 20, 2010 at 9:19 am

I still don’t get why people aren’t “allowed” and I never can see the difference between being able to use an epi pen and glucagon. These people are charged with the care of our children. I would hope that in a life saving situation that people would step up and do it.

If there are state laws, then we need to change them! (Rally the troops!)

Our kids are tough!

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5 Joanne August 20, 2010 at 9:07 am

A low dose glucagon kit would be awesome. I just finished typing up Elise’s Care Manual for when someone else has to look after her, and when I typed up the part about the glucagon, I bolded, underlined and made the font larger where I wrote about Elise only needing a half dose. And I wrote it out several times (once in the explanation, once in the step-by-step process of how to administer it, and one more time at the very end), and I’m still nervous that I won’t get the point across.

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6 Leighann August 20, 2010 at 9:15 am

Joanne- I’ve heard (but don’t quote me on this, it’s a good question for a CDE) that if they get the entire vial of glucagon that it will make them vomit, but it isn’t really harmful.

I also hear differing recommendations at what weight they begin getting the full dose. My daughter is 52 pounds and the CDE said 1/2, but I saw a training video from Lilly, if I recall, that says over 42 pounds they get all of it.

I guess it’s just like every other thing with diabetes: there are multiple answers and who knows which one is right.

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7 Janice August 21, 2010 at 5:05 pm

My daughter has had type 1 for five years and we have never used the glucagon. She is 8 1/2 now. The glucagon I have expired in 12/08. I sent it to the school last year and they never noticed but I am guessing they will notice this year. So I went to get some new glucagon at the pharmacy and was surprised that it was going to cost $115. The pharmacist said it would be $165 w/o insurance. I was wondering why it costs so much. I looked online and there is a canada web site where I can get it for $76. I have ordered Humalog from them before for 1/2 what I pay here and had no problems. I don’t mind paying whatever if I know my kid will need it but we have never used it and I wonder that if she ever needed it, if the folks at her school would know how to use it. I know the school nurse would but I am guessing the other staff might not know what to do and she is only there 3 days a week.

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8 Leighann August 22, 2010 at 1:40 am

Wow Janice, that seems expensive for glucagon even with insurance. I wonder if there is any sort of appeal you can make to get better coverage or if Lilly has an assistance program that would give a price break.

Have you done teacher training on it? Is staff “allowed” to do it? (I keep hearing that some schools/states say no.)

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9 Laurel August 22, 2010 at 5:42 pm

Leighann-

We’ve used the glucagon once and it was to fight an extremely stubborn low after the flu set in and Hannah had thrown up a 92 carb meal less than an hour after eating.
One tip, after having had to try and use the horse needle (half my distress came from trying to “pop” that needle in) the kit comes with, I would advise that you use an insulin syringe. Much easier to inject with and while I’ve not had to pull out the big guns since that episode, I know that I can if she gets really sick again. Our endo suggested using it in 1/10 doses as it can be kept for 24 hours after mixing. Our endo’s office also told us that the expiration date is a loose one and to not worry about it for at least a year after. My fear is how do you know?

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10 Renata August 29, 2010 at 2:28 pm

We’ve never used one either, but still have them and train friends on them. I always wondered about the expiration date. Seriously,it’s glucose how does that expire?

When I train I usually start off by saying it looks hard but it’s not. “This liquid here has to be added to this vial. You shake the vial so it’s all mixed up, then you pull it all back into the syringe.” Then I actually walk them through the steps. I tend to get a better reaction when I break it down into 3 steps…then I tell them to not stress and just jab it into their legs. “Don’t worry about bruising and hurting, worry about brain damage. ” Then I laugh when I see them “Jab” it into an orange or apple.

I agree on the smaller dosage. I have heard that it makes the person sick afterwards…does anyone know about that?

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11 Daniel Green September 30, 2010 at 12:45 pm

Enject is indeed developing a pediatric version of GlucaPen which will be called GlucaPen Jr, and which will deliver half the adult dose.

To stay up to date on GlucaPen developments, join the Facebook Group “GlucaPen and GlucaPen Jr”

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12 Leighann October 1, 2010 at 9:42 am

Thank you Daniel. Keep us posted on the product’s development, approval, and release date.

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13 Scott December 8, 2010 at 10:31 pm

Hey all, I myself am an 18 year old diabetic and have been since the age of five. Congruent to your testaments, I have never had to use a glucagon pen. Yes, it is a great idea to have one at hands at all times, but I hope I can put you at ease a little bit….

The only time I have ever possibly needed to use my pen was on a backpacking trip, lugging an 80 pound backpack across the North Georgia mountains in the pouring rain (it actually flooded that day). At this point we had traveled several miles and due to the strenuous conditions and exercise my blood sugar took a dive. The real problem though, was that I had never taken care to adjust my basal rate, so at this time my insulin pump was still pumping hourly rates of insulin into my body at a time which I would normally be eating lunch at school. The result was terrible, my body began to shut down and I had to eat and drink all of my friends supplies. My stomach was full but my blood sugar was LOW. It felt terrible, physically and emotionally. I began dreaming and praying that a rescue helicopter would come out and save me.

Now I said I hoped to put you at ease, so here it is: Fact is, it took a lot of neglect and misjudgement to drive my blood sugar that low. My knuckle-headed self was the sole reason for that disastrous episode. However, for your kids being around school, the soccer field, or at a friends house I’d say you don’t have anything to worry about.

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14 donna schindler January 14, 2011 at 8:57 pm

I have been following the Enject easy to use portable pen invented ny Richard Rylander for MONTHS now. It was bought by Merck, then Lilly, now the parent companyMarcadia Biotech was bought by Roche (as of Jan 2011) and still no convenient portable easy to use glucapen!! WHYYYYY???? Do they think it will cost them money in the long run to have an easy way to treat hypos?? I am scared of the horrible design and of the Lilly Glucagon and feel it will be used incorrectly if needed at school. I know MANY parents would LOVE the glucapen just for peace of mind alone!!! Why cant we have this?????!!!

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15 Samantha August 13, 2011 at 7:21 pm

I totally disagree with Scott. I have been with a type 1 diabetic for 2 yrs. Married for 1. He usually has pretty tight control over his sugars, but this morning he woke up low, felt he was low so he tested. He was at 66, which is usually functioning for him. He went into the kitchen to make himself a bowl of cereal. I watched him the entire time while I was feeding the baby. I think I almost had a heartattack when he passed out, but amazingly went into autodrive, putting the baby down and running for his tester. His head hit the tile floor hard. He had a seizure (from the head injury, not the low). I held him down as directed while he seized, all the while calling 911 and preparing his omnipod pdm for a test. He tested at 101 after his seizure. I then called his mother, who was down the street, and told her to rush over, my mother to come stay with the kids (which took about 30 seconds). I then tested him again and he was at 79 but still not at himself. I could tell he knew who I was but he couldn’t speak or respond in a blinking fashion. He was not combative though, which confused me. My husband is normally combative with a low that severe. When his mother got here (before the ambulance which is sad), she told me even though his eyes were open and he appeared to be awake that he still needed his glucagon, which I quickly retrieved and administered. Almost immediately he was completely at himself, just a lot confused. He was transported by ambulance to our local hospital, then by his mother and I to St. Francis, where his endo sees him. He suffered a massive concussion with injuries to head and face from the fall, and he has no memory of anything between going to sleep and being in the ambulance. It doesn’t matter how well you think you have your diabetes under control, you should always keep your Gshot with you everywhere you go. You never know. He has had type one since he turned 6. Experience means nothing. Stuff happens all the time. Everyone, please keep your Gshots with you and close to anywhere your child might be. Always better to be safe than sorry, right? I don’t know what I would’ve done today if the Gshot hadn’t been in an accessible spot.

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