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‘Mini-dose’ glucagon viable option for hypoglycemia in type 1 diabetes
Treatment with a “mini-dose” of ready-to-use, subcutaneous glucagon is an effective, alternative treatment for hypoglycemia in adults with type 1 diabetes, according to recent study findings.
“Mini-dose glucagon provides the opportunity to treat mild hypoglycemia without the consumption of additional calories, and may well avoid the problem of glycemic overshoot often observed with oral carbohydrate treatment of mild to moderate hypoglycemia, and without any nausea or other side effects associated with large doses of aqueous glucagon,” Morey W. Haymond, MD, professor of pediatrics and nutrition at Baylor College of Medicine in Houston, told Endocrine Today. “Having a liquid glucagon product that is stable at room temperatures over long periods of time, and in a ready-to-use device, will make this easy to use (not requiring reconstitution of lyophilized glucagon) and, hopefully, very patient acceptable.”
Morey W. Haymond
Haymond and colleagues analyzed data from 12 adults with type 1 diabetes who were using insulin pump therapy. They received mini-dose glucagon on three occasions separated by 2 to 21 days (eight women; mean age, 26 years; mean BMI, 25 kg/m²; mean diabetes duration, 12 years). On each study day, researchers assigned participants subcutaneous doses of 75 µg, 150 µg or 300 µg of nonaqueous liquid glucagon (G-Pen Mini, Xeris Pharmaceuticals). Doses were randomized across study days; plasma glucose, glucagon and insulin concentrations were measured. Participants received insulin 180 minutes later, followed by a second, identical dose of glucagon 60 minutes later.
Mean fasting glucose concentrations were 110 mg/dL for the 75-µg and 150-µg doses, and 109 mg/dL for the 300-µg doses, increasing maximally at 60 minutes by 33 mg/dL for the 75-µg dose, 64 mg/dL for the 150-µg dose and 95 mg/dL for the 300-µg (P < .001 for all).
Post-insulin administration glucose concentrations were 70 mg/dL, 74 mg/dL and 70 mg/dL, respectively, with maximal increases of 19 mg/dL, 24 mg/dL and 43 mg/dL post-glucagon administration (P < .02 for all) at 45 to 60 minutes.
“The T1D Exchange at the Jaeb Center, in collaboration with the Helmsley Charitable Trust, are conducting an at-home clinical trial comparing mini-dose glucagon and oral glucose treatment of mild hypoglycemia to assess efficacy and patient acceptability,” Haymond said. “It will be exciting to anticipate these studies and to see this product come online and be available for our patients.” – by Regina Schaffer
For more information:
Morey W. Haymond, MD , can be reached at 1 Baylor Plaza, Houston, TX 77030; email: mhaymond@bcm.edu.
Disclosure: Four of the study authors are employees of Xeris Pharmaceuticals.