The Eli Lilly Company recently announced that it will stop producing and selling its emergency glucagon injection kit used to treat severe hypoglycemic episodes. In Canada, the product will no longer be available as of June 2023. The decision was made due to the decreased demand for injectable glucagon ever since nasal glucagon was made available. This new form of glucagon is also covered for people aged 4 and older.
Many parents of children with type 1 diabetes (T1D) under 4 years old and parents who use injectable glucagon to administer microdoses when their children are sick (e.g., gastroenteritis) are concerned about this announcement. However, there’s no need to worry or to stock up, as the GlucaGen HypoKit (Paladin Labs/Novo Nordisk Canada) will still be available in Canada.
What is glucagon?
Glucagon is a hyperglycemic hormone produced by the pancreas when blood sugar levels drop. However, this mechanism can be altered in people with T1D, especially when they administer a higher dose of insulin than necessary (e.g., too much insulin for the number of carbs).
Should a person with T1D experience an episode of severe hypoglycemia (i.e., they lose consciousness or are unable to take sugar by mouth), someone else will need to step in and administer injectable or nasal glucagon. Studies have found that nasal glucagon is easier to handle, meaning that the person receives their dose faster. This is especially true for school staff who look after children with T1D. However, both nasal and injectable glucagon are equally effective in treating severe hypoglycemia.
Educate your loved ones
Data from the BETTER registry show that each year, more than 10% of people with T1D experience severe hypoglycemia, and that this type of episode is considered very traumatic.
If you or your child live with T1D, make sure you regularly review the steps for administering glucagon. Also be sure to educate those around you (family, school staff, co-workers, etc.) and to tell them where to find glucagon in case of an emergency. The BETTER team has produced two videos to explain how to administer nasal and injectable glucagon.
Here is the recommended procedure for treating severe hypoglycemia:
- Administer glucagon: blood sugar levels should rise within 15 minutes.
- Call an ambulance, especially if it’s a child
- When the person is able to swallow again, they should eat a snack with carbohydrates and protein.
- After the episode, contact your healthcare team to discuss what might have caused it and what can be done to reduce the risk of it happening again.
Injecting glucagon microdoses
Glucagon can also be useful during sick days. The risk of hypoglycemia may increase when sugar cannot be absorbed by the mouth. This is the case when a child vomits their meal after having taken insulin. Using injectable glucagon, microdoses can be administered to treat or prevent hypoglycemia.
Dosage for a child should be discussed with their healthcare team, who will determine the proper dose based on the child’s age, weight and health status. Health Canada hasn’t validated this use of glucagon, but experience shows that it meets very important punctual needs in pediatrics.
Injectable vs nasal
Whether it’s injected or inhaled, the hormone in both products is the same. If you’re currently using Eli Lilly’s glucagon kit and wish to keep using injections, you can ask your or your child’s healthcare team to prescribe GlucaGen as a replacement. Take this opportunity to review the proper dose for a child with severe hypoglycemia. As a rule of thumb, children under 6 years of age should be given half the injectable dose, depending on their weight.
Finally, check how to properly store both forms of glucagon, as well as the expiration date. GlucaGen will keep outside of the refrigerator for 18 months at room temperature (25˚°C and below). You can also keep it in the refrigerator (between 2 and 8˚°C) to extend its shelf life. As for nasal glucagon, the shelf life is of 2 years from the date of manufacture when properly stored in its plastic packaging, and the product will withstand temperatures up to 30˚°C. Make sure to note the expiry date when you purchase them at a pharmacy. It should usually be good for around 18 months.
Whether it’s in nasal or injectable form, make sure you always have glucagon on hand!
References :
Lilly, Mise à jour sur la cessation de vente : Trousse d’urgence de Glucagon, consulté le 20 avril 2023, https://www.lilly.ca/fr-CA/nouvelles/communiques-de-presse/22.08.25-glucagon-cessation-de-vente
BC Children’s Hospital, Mini-Dose Glucagon for Preventing Serious Hypoglycemia, consulté le 25 avril 2023, http://www.bcchildrens.ca/endocrinology-diabetes-site/documents/minigluc.pdf
Haymond M W, Schreiner et B, 2001. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes, consulté le 25 avril 2023. https://pubmed.ncbi.nlm.nih.gov/11315823/
Eli Lilly, Monographie Glucagon, consulté le 23 avril, https://pi.lilly.com/ca/fr/glucagon-ca-pm-fr.pdf
Eli Lilly Canada, Monographie du Baqsimi, consulté le 1 mai, https://pi.lilly.com/ca/fr/baqsimi-ca-pm-fr.pdf
Paladin Labs, Novo Nordisk Canada. Monographie du GlucaGen, consulté le 22 avril, http://www.paladin-labs.com/our_products/Glucagen.PDF
Yale JF, Dulude H, Egeth M, et al. Faster use and fewer failures with needle-free nasal glucagon versus injectable glucagon in severe hypoglycemia rescue: A simulation study. Diabetes Technol Ther. 2017;19(7):423–432.
Madar, Houssein et al. Influence of severe hypoglycemia definition wording on reported prevalence in adults and adolescents with type 1 diabetes: a cross-sectional analysis from the BETTER patient-engagement registry analysis. Acta diabetologica vol. 60,1 (2023): 93-100. DOI: 10.1007/s00592-022-01987-9
Brazeau, Anne-Sophie et al. Self-reported Severe and Nonsevere Hypoglycemia in Type 1 Diabetes: Population Surveillance Through the BETTER Patient Engagement Registry: Development and Baseline Characteristics. Canadian journal of diabetes vol. 46,8 (2022): 813-821. DOI: 10.1016/j.jcjd.2022.05.010
Written by: Nathalie Kinnard, scientific writter and research assistant
Reviewed by:
- Sarah Haag, RN. BSc.
- Jacques Pelletier, Claude Laforest, Andréane Vanasse, patient partners of the BETTER project
Linguistic revision by: Marie-Christine Payette
Upcoming Events
