Taking the Fear out of Low Blood Sugar: Next-Generation Glucagon
By Natalie Sainz and Arvind Sommi
At diaTribe Musings, four expert panelists taught us how emergency glucagon can save lives during severe hypoglycemia. Read their insights on the future of glucagon and how people with diabetes can advocate for themselves.
Hypoglycemia can be scary and stressful for those living with diabetes. Severe hypoglycemia is life threatening – according to the CDC’s 2020 National Diabetes Statistics Report, in 2016 alone 235,000 people went to the emergency room as a result of the condition.
When someone is experiencing severe hypoglycemia, their blood sugar levels are too low for the brain to function. Prior to 2019, if the person was conscious, they could consume either carbohydrates or glucose tablets to raise their glucose levels, or they could use one of the old-style glucagon injection kits. If unconscious, an ambulance had to be called. But there’s good news: Since 2019, next-generation emergency glucagon provides easy-to-use alternatives for raising glucose levels in emergency situations. For more background on emergency glucagon, click here.
Preventing dangerous hypoglycemic episodes was the focus of The diaTribe Foundation’s May 13 Musings panel discussion, “Taking the Fear out of Low Blood Sugar: Next-Generation Glucagon.” Hundreds of people participated in the live event, taking part in an in-depth discussion with expert panelists on the potential for new advances in glucagon. You can watch the event here.
Four highly-regarded advocates for rescue glucagon joined the Musings conversation with diaTribe Founder Kelly Close:
Crystal Bowersox, Musician & Patient Advocate, Lilly Diabetes
Paul R. Edick, Chairman & Chief Executive Officer, Xeris Pharmaceuticals
Dr. Steven Russell, Associate Professor of Medicine, Harvard Medical School; Massachusetts General Hospital Diabetes Research Center
Dr. David Kendall, Endocrinologist & Senior Global Medical Advisor – Metabolism, Zealand Pharma. (Dr. Kendall was an invited panelist who provided information for the panel and quotes for inclusion in this article).
Unfortunately, recent data from diabetes market research company dQ&A shows that less than half (45%) of people with diabetes on insulin currently have emergency glucagon. The panelists have hope that this will change. The goal is for next-generation glucagon to become a common tool in diabetes kits as people with diabetes and their healthcare professionals become aware of its immense benefits and ease of use. If you are looking for resources on affording diabetes treatments, including glucagon, click here.
On the importance of rescue glucagon
“I’m a performer and lows happen anywhere, anytime even if you’ve taken all the precautions. I’ve had lows on stage during performances and have needed assistance, so having a rescue plan is important. Part of that is having the people around me know what to do if the situation arises.” - Crystal Bowersox
“If someone can’t take carbs because they are confused or unconscious, a shot of glucagon can bring them back. If they are not unconscious but still can’t eat carbs, [glucagon] is another option to raise blood glucose safely. It’s a lot more complicated to have an ambulance come out to give an IV. Bystanders and loved ones can treat hypoglycemia more easily with glucagon.” – Dr. Steven Russell
“The bottom line is if you are on insulin, you are at risk of a severe low – so anytime an insulin prescription is written, a glucagon prescription should also be written.” - Paul Edick
On advocating for rescue glucagon
“The ADA guidelines say that if you are on insulin, you should have glucagon handy, but only 10% [of people on insulin] fill a prescription for any form of glucagon in any given year. Six million people should be filling a prescription for glucagon.” - Paul Edick
“If you don’t already have access, ask your healthcare provider to prescribe glucagon for you because it really is important. We’re trying to make sure everyone has access.” - Dr. Steve Russell
“Advocating for yourself is so important… If you're going to see your healthcare provider you should make a list when you're clear headed. Time can be a precious commodity in the office. You don’t want to leave without having an emergency rescue plan.” - Crystal Bowersox
"Everyone listening has the opportunity to be an advocate. Advocate with your local, regional, and national organizations to ensure that rescue therapies are a standard. Rescue therapies – just like supplies, continuous glucose monitors, access to care – are a necessary and essential part of one’s diabetes management plan. We are working with the professional organizations, and payers and healthcare systems to ensure that rescue therapies are prescribed. Demand it! Advocate for it. And we will work with ADA, EASD, and your healthcare plans to make this a standard for your care." - Dr. David Kendall
“There are situations where I’m worried that I'm going to go low, and it's going to be a problem, and I want to have that ready to use auto-injector just in case. If you never use it, great, but never feel like you’re being a bad patient by asking your doctor for it.” - Paul Edick
On the future of mini-dosing glucagon
“I think it really is an appealing idea to be able to have an alternative to taking carbs for lows, especially around exercise – people are trying to be fit, and it can be frustrating for folks to have to consume more carbs, more calories than they’re using… I really hope that the FDA and the companies can find a way forward to make [mini-dosing] possible.” - Dr. Steve Russell
“We are studying it in exercise, so can you use a little bit before exercise and not have a low? And can you do that without having to change your insulin or eat candy bars while you’re on the treadmill? We’re plowing a new field here.” - Paul Edick
On the single biggest thing to leave people for 2021
“I would say that everybody should have an easy-to-use rescue plan which should involve ready-to-use glucagon. And if your provider doesn’t propose it, you should ask and make sure that happens. I wouldn't wait until your next visit, I would reach out.” - Dr. Steven Russell
“If you’re on insulin you should have a rescue plan and that should include glucagon. I would encourage healthcare providers to think more about prescribing glucagon.” - Paul Edick
“During this pandemic we’ve learned so much about ourselves and what’s important. I think what’s so important is hope and knowledge – we’re empowered by hope and knowledge as people with diabetes. Knowledge is power, so have a plan in place." - Crystal Bowersox
"In the future, we should ensure that all patients, all caregivers, all of those affected by diabetes and all at risk for hypoglycemia have access, not just to glucagon rescue products, but to all the tools that improve their lives, improve their care, and improve their outcomes." - Dr. David Kendall
Thank you to our generous sponsors for making this outstanding conversation on such an important topic possible!