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.