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August Blog: Out with the old, in with the new: Lilly to discontinue glucagon emergency kits

By Katelyn O'Brien posted 08-22-2022 18:52

  

Out with the old, in with the new: Lilly to discontinue glucagon emergency kit.

How to use: https://uspl.lilly.com/glucagon/glucagon.html#ug

As you can see there are many steps to preparing a glucagon kit – time is of the essence in an emergency situation! With more modern and ready-to-use glucagon options now available, Lilly will be discontinuing the old, red Glucagon Emergency Kit (GEK) in all markets. The phase out will begin December 31, 2022. The generic GEK will still be available from Amphastar Pharmaceuticals.

What is Glucagon?

Glucagon is a hormone the human body produces to prevent low blood sugar—but in people with diabetes, this natural production isn’t enough during severe hypoglycemia. Emergency glucagon is a medication used when a person with diabetes is experiencing severe hypoglycemia and cannot take glucose orally. Once injected, it raises the blood sugar by sending a signal to the muscles and liver. The effect of glucagon is opposite of the effect of insulin, raising blood sugar instead of lowering it. The American Diabetes Association (ADA) recommends that glucagon be prescribed for all individuals with diabetes at risk of level 2 or 3 (table 1) hypoglycemia, so that it is available when needed. Caregivers, school personnel, or family members providing support to these individuals should know where it is and when and how to administer it. It comes in several forms including a nasal spray, auto-injectors, prefilled syringes, or a powder that must be mixed with a liquid before injecting. See table 2 below comparing the various “ready-to-use” glucagon products.

Table 1 – Classification of Hypoglycemia

 

Glycemic Criteria

Level 1

Glucose <70 mg/dL but ≥54 mg/dL

Level 2

Glucose < 54 mg/dL

Level 3

A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia

 

Table 2 – Ready to Use Glucagon Products

Glucagon Product

Baqsimi

Gvoke

Zegalogue

Device

Nasal spray

Pre-filled syringe, auto-injector

Pre-filled syringe, auto-injector

Route of Administration

Intranasal

Subcutaneous

Subcutaneous

Indication

Treatment of severe hypoglycemia in ages 4 and older

Treatment of severe hypoglycemia in ages 2 and older

Treatment of severe hypoglycemia in ages 6 and older

Pediatric Dosing

3mg

2-11 years: 0.5mg

0.6mg

Adult Dosing

3mg

12+ years (100 lbs): 1mg

0.6mg

Contraindications

Pheochromocytoma and insulinoma

Adverse Reactions

Vomiting, headache, nausea, upper respiratory tract irritation

Nausea, vomiting, injection site edema

Nausea, vomiting, headache, diarrhea (adults only) and injection site pain

 

General Management for Severe Hypoglycemia:

  • Call for emergency medical assistance
  • For injections, sites for administration include abdomen, outer upper arms, front or backs of thighs, and buttocks
  • If person with diabetes is unconscious, turn them on their side
  • If there is no response after 15 minutes, an additional dose of glucagon can be administered
  • Once the person with diabetes has responded, encourage them to eat to prevent a recurrence of hypoglycemia
  • Ensure person with diabetes obtains refill on glucagon product

Role of Pharmacist and CDCES:

  • Pharmacists/CDCES on the diabetes care team can help identify insurance coverage for newer glucagon devices as well as assist with coupons for cost savings
  • Pharmacists/CDCES can educate patients and care givers on use of new devices when transitioning from the Lilly GEK to a newer ready-to-use device

References:

ADA Standards of Care. 6. Glycemic Targets. 2022;45(suppl. 1):S83-S96.

Baqsimi {prescribing information}. Indianapolis, IN. Lilly. 2020.

Gvoke [prescribing information]. Chicago, IL: Xeris Pharmaceuticals, Inc; 2021.

https://beyondtype1.org/glucagon-options-old-new/

Zegalogue (dasiglucagon). [prescribing information]. Zealand Pharma. April 2021.

 

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Comments

08-24-2022 13:45

Thank you for sharing this information!

08-24-2022 08:34

Thanks for putting this together! I'm going to share with my providers in clinic.

08-24-2022 08:06

This is a great update and good reminder on how to use these products, thank you for sharing!