US NEWS: Emergency Services Crews Often Unprepared for Diabetic Crises
By Serena Gordon
HealthDay Reporter
FRIDAY, Jan. 26, 2018 (HealthDay News) -- If you call 911, you expect to get the medical services you need.
But new research suggests that when it comes to severe low blood sugar episodes in people with diabetes, first responders might not be able to administer a potentially lifesaving medication called glucagon.
Glucagon is an injectable medication that prompts the liver to release stored glucose. This quickly raises blood sugar.
But paramedics can give the injections, said Dr. Craig Manifold, medical director of the National Association of Emergency Medical Technicians. That's because paramedics get between 750 and 1,500 hours of education compared to about 100 to 150 hours of training for EMTs.
Low blood sugar levels (hypoglycemia) generally occur in people with type 1 or type 2 diabetes taking insulin or other blood sugar-lowering medications. Researchers said more than 100,000 serious hypoglycemia episodes occur each year.
Gabbay noted even U.S. Supreme Court justices aren't immune to this problem. Earlier this month, Justice Sonia Sotomayor, who has type 1 diabetes, had to call emergency services for help with serious low blood sugar.
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Nasal Glucagon Study in Phase 3
SAN DIEGO — Giving one puff of a dry glucagon powder inside the nose of an adult with type 1 diabetes who was having a moderate to severe hypoglycemic episode was easy for a caregiver to do and led to recovery within 30 minutes in almost all patients in a phase 3 study.
Specifically, the treated patients recovered from hypoglycemia within a half hour in 96% of cases, and 90% of the caregivers (typically a spouse) found the product easy to use, Elizabeth R Seaquist, MD, University of Minnesota School of Medicine, Minneapolis, reported at the recent American Diabetes Association (ADA) 2017 Scientific Sessions.
“It is premature to comment on when the product will be available in the US,” he cautioned, but if the NDA is approved, “we are excited to bring this product to market as quickly as possible.”
"We conclude that this 3-mg dose of nasal glucagon in a needle-free, user-friendly package provides a potential alternative to currently available injectable recombinant glucagon," she said.
"It really does look like [this investigational product] could be a good alternative to [intramuscular injectable] glucagon for treating severe hypoglycemia away from a hospital setting," she reiterated to Medscape Medical News.
Glucagon Nasal Spray Effective for Hypoglycemia Rescue
Spray device easier for untrained people to use, experts say...
- Intranasal glucagon is effective and noninferior to injectable intramuscular glucagon for the correction of insulin-induced hypoglycemia in adults with type 1 diabetes, according to a randomized, cross-over study.
- Note that hypoglycemia was induced by administering insulin in a controlled setting, but this approximates the real-world setting of severe hypoglycemia occurring due to excessive therapeutic insulin with inadequate or absent endogenous glucagon response.
- An intranasal glucagon spray was as good as injectable glucagon for treating induced hypoglycemia in patients with type 1 diabetes, according to a randomized crossover noninferiority study.
- The effect of the nasal spray lagged a few minutes behind that of injections, but it met the study's pre-defined success criteria 74 out of 75 times, compared to 75 out of 75 with injectable glucagon, reported a team of investigators led by Michael Rickels, MD, of the University of Pennsylvania in Philadelphia.
- Currently, only injectable glucagon is available for treating hypoglycemic episodes, and it comes in a powder that must be reconstituted in a diluent before injection.
- The intranasal glucagon, developed by Locemia Solutions, is in phase III clinical testing. Eli Lilly recently announced that it acquired worldwide rights to Locemia's intranasal glucagon and plans to bring it to market.
Check out an episode of the Juicebox Podcast today...
Glucagon App for Caregivers
Eli Lilly has designed an app that helps caregivers to understand how to reconstitute and administer Glucagon. It's worth checking out.
Long before we had an OmniPod insulin pump or a Dexcom CGM we managed Arden's BGs with a syringe and a little meter. One day, armed with only those tools, I tried and failed to fight the evil Chinese food monster. Shortly after the meal Arden laid sleeping in her crib, having her afternoon nap.
In an instant things went from normal to not and Kelly and I found ourselves kneeling around Arden on the floor tending to a seizure. While Kelly was opening fast acting glucose gel, I was staring at our glucagon, incapable of recalling the steps I was taught in the Endo's office. Thankfully, the gel worked and we never needed the glucagon but you can be sure that I changed my perception that. "this could never happen to us" and taught myself how that little red kit worked the very next day.
I always suggest using outdated glucagon kits to practice with and once you have the process down, give the next one to your school nurse so they can do the same. While I don't think that an app can replace the experience holding that glass syringe in your hand and getting accustomed to how it feels, this app goes a long way toward getting you ready for the experience.
Take it from me, if the day comes when you need glucagon... you do not want to be reading instructions.
The app is available for iOS and Android.
One year after the experience I described Arden talked about what it was like to have a seizure. I captured her candid and impromptu conversation on video. It's an old video that is somewhat sad to watch, but even though current diabetes management technology goes a long way toward stopping things like this from happening - it's very worth understanding what you are guarding against.
Expired Glucagon
I think that we can all agree that the best Glucagon is the one that you never open. I understand how uplifting it is to toss a Glucagon kit into the trash, nothing feels better than knowing that it was never opened - but what if I told you that there was something better? Something easy and awesome that you can do with your expired Glucagon?
Practice. Practice. Practice.
My best advice for what to do with your expired kits, practice. Parents, siblings, friends and relatives will all benefit from being able to learn how to help in a severe low blood glucose situation. I know that we all hope and want to believe that we will never have to use Glucagon in an emergency situation, but just in case, the first time you hold one shouldn't be during a seizure.
This I know from experience.
Not long after Arden's diagnosis back in 2006 we tried to eat Chinese food for the first time since diabetes entered our lives and well, that didn't go very well. I injected too much insulin and about two hours later, Arden was having a seizure. We placed Arden on the floor, Cole called 911 and Kelly began to rub glucose gel into Arden's cheek while I was frozen and staring at the Glucagon. "I never thought I was going to need to know how to use it", I mumbled. Thankfully, the gel Kelly applied brought Arden out of the seizure but I'll never forget the sickening feeling of having the tools to help my daughter in my hands but not the knowledge of how to use them.
So practice with your expired Glucagon until it doesn't feel awkward. Then once everyone in your life is proficient -- donate them to your child's school nurse or a local school.
Glucagon is the only thing in the world that I buy hoping that I will waste, but you don't have to throw it away. School nurses, Glucagon proxies and other school personnel will be grateful for the opportunity to get comfortable with the process. Speak with your school nurse and ask if an expired Glucagon kit is something that they'd be interested in having and you'll feel twice the pleasure the next time a kit expires.