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The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

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#789 Important Things to Know About Gvoke HypoPen® (glucagon injection)

November 14, 2022Scott Benner

Scott and Jenny discuss the important things to know about Gvoke HypoPen® (glucagon injection)

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to another episode of The Juicebox Podcast.

On today's podcast Jenny Smith and I will be talking about G voc hypo pet, we'll go over the construction of the device, its operation, where on the body you can use Chivo Capo pen. We'll also talk about when to start thinking about using glucagon. We'll talk about the people in your life that you should tell about your diabetes and see if they'd be willing to help you in an emergency. And if you should have to use Jeeva hypo pen, what do you do next? All of that and more on this episode of The Juicebox Podcast. G voc hypo pen has no visible needle and is a premixed auto injector of glucagon for treatment of very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. Before we get started today, I would like to tell you that xirrus has paid the host of this podcast that's me Scott Benner and his guest, Jennifer Smith, a fee to create this content. Hey, Jenny, how are you? I'm great. How are you? Scott? Thank you. I appreciate you doing this with me today. Of course, I have to say a couple of things here. We don't usually do this together. But nothing that is said here constitutes advice, medical or otherwise, always consult with a health care professional before making changes to a health care plan. Okay, Jenny, you're never here for that part.

Jennifer Smith, CDE 1:51
I'm not usually I'm assuming you just add that in at some point. Right?

Scott Benner 1:56
That is what happens. G voc is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor, starvation, chronic low blood sugar, or allergy to evoke High Blood Pressure hyperglycemia and serious skin rashes can occur. Call your doctor or get medical help right away. If you have a serious allergic reaction including rash, difficulty breathing or low blood pressure. Visit Jeeva glucagon.com/risk for more information. So I know you know this but a lot of people listening might not know that on December 31 2022. After decades on the market, Eli Lilly and Company is discontinuing distribution of their glucagon emergency kit. Yes, they are. So we're talking about the I mean, the one everybody must have right, the little red kit with a powder in it. And you Yep. What do you

Jennifer Smith, CDE 2:52
do? Absolutely. The the old time I've had many, many of them over the years and all of them have gone in the garbage as of the expiration that's on the package, and then I just refill it.

Scott Benner 3:04
We used to give them to art in school so the nurses could practice with them. That's a great idea. Yeah. Having said that, a lot of that's not necessary anymore, because there have been a lot of innovations in the glucagon market. For instance, jeuveau hypo pen where I'm holding the pen right now I have a trainer pen. It's not the actual one. I know you have it too. I do. This thing is super simple in terms of administration. So we're gonna go over how it works in just a minute. It's a pre mixed and ready to use glucagon option that has a reliable method of delivering during critical moments of severe hyperglycemia. So now because the glucagon emergency kit has been discontinued, people who have that Eli Lilly g k prescription will need to be prescribed a different option. Yes, you should talk to your healthcare provider about your options. But we're here today to talk about G voc hypo pen, because I think it's a terrific option. It is the glucagon that my daughter carries.

Jennifer Smith, CDE 3:56
Yes, it's also one that I have in the cupboard and multiple other places in my home. I travel with it. So it's great.

Scott Benner 4:06
You have it in your on your person when you leave the house. I do. Yes. Okay. Arden does as well. And I have to say that this is the first time in I don't know how long 14 or 15 years of diabetes that art has actually been able to travel with glucagon because of Jeeva hypo Penn's simple two step administration. Chico Kibo plan is designed for trained and untrained individuals to successfully use in emergency situations. People can even self administer G voc in certain situations. It allows diabetics and their loved ones to treat severe low blood sugar emergencies with confidence. G Bo Capo pen is a ready to use rescue pen that everyone on insulin would benefit from. G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit je voc Luca don.com/risk. It's gonna seem like I read that and I probably did, but I actually mean it seriously We're going to talk about the build of the pen. How it's used, which maybe couldn't be. I mean, like I said, two steps, there's not a lot to talk about.

Jennifer Smith, CDE 5:08
It's very simple.

Scott Benner 5:09
Yeah, yeah, we're actually going to talk about where you can use it on the body, and a lot else. So you have your pen in front of you.

Jennifer Smith, CDE 5:17
I, yes, it's actually just underneath my desk here. Let me grab it. What else is under your desk? Well, you know, I have a riser desk with a treadmill underneath it. So I have, you know, a desk space underneath to be able to pull out multiple things while I'm talking to people. And educating Well, you know, you have to be right. Otherwise, I'm like, I have to run out of the room for this, right? That's not helpful.

Scott Benner 5:41
No, so you have yours, I have mine. These are trainer pens, they're not real, but they're, you know, a facsimile of what you get when you use Chivo type of pen. So, I mean, it's about the length of a pen, and width of a tiny cigar, maybe, you know, a half inch maybe around,

Jennifer Smith, CDE 5:58
there's actually say simply, it's kind of about the size of an insulin pen. Honestly, like, you know, the barrel of it seems to be about like, and in terms of a pen size, you're right. It's like a thick marker, almost.

Scott Benner 6:12
Yeah, that's a great way to put it, it's like it's like a marker size. There's a window on it. So that you can see after the glucagon has been administered, I'm looking at Jenny holding it up, and a red cap on the end. So it is cap off. Then you see this yellow, and to it, you find a place on the body to use the pen. Now here's where you can use it on the front, abdomen left and right under your belly button. Yes, top to your thighs and upper arms. Press down. The window gets read once it's done administering. And that's it. It's in. That's pretty.

Jennifer Smith, CDE 6:50
I love the fact that you can also hear

Scott Benner 6:54
the clicks. Yeah.

Jennifer Smith, CDE 6:56
As it's working, right? You pull the red cap off, like you said, put it in the location. And you hear the click. And that's it's a great way. And then I love the viewing window. The fact that you can actually see when it's completely read and done. It's It's wonderful to know that it was completely lost. And then of course, counting to five. Once you see that is the next kind of important step.

Scott Benner 7:21
Right? Well, I have to say the minute I saw it, I thought my daughter can finally carry glucagon with her. Yes. I mean, I don't know how it's been for other people. But it was hard to find people in her life, to train to use glucagon. And now it's, I mean, it's, it just couldn't be easier. We Arden just moved into college. And we got her roommates together at a lunch and went over all of this not one confused face, nobody was like, Wait, I don't understand, you know, they don't see a needle. So that keeps them calm. You know, there's people who are not accustomed to using insulin, not accustomed to seeing needles. And these are the people who might be helping you when you need help.

Jennifer Smith, CDE 8:01
Correct the fact that there's no mixing, there's nothing additional you have to do to utilize this, like, you know, it's just pull it off, stick it in the right part of the body and click and count to five. That's pretty, pretty nice, especially from the fact of, you know, the the age group of people using this is to and up. Correct. So when we kind of look at that in terms of training people, both trained and untrained, if you'll call them professional versus unprofessional, clinician, et cetera, et cetera. It's a great device that you don't have to see anything. That's scary.

Scott Benner 8:42
Well, I'll share a story from right after Arden was diagnosed, we went to the food court and tried to do I think Arden had had diabetes for like six months, and everything was going like really well, we thought. So we got kind of heavy and gave her some food court Chinese food. And we got home put her down for a nap, she was only two. And a little while later, we heard this grunting coming out of her bedroom. And when I went in there, it took me a minute to figure out that she was having a seizure. So I picked her up and brought her out to where Kelly was, and we later on the floor. And I pulled out that red box. And I froze. We really did. She had only had diabetes for six months. And the extent of what I knew about glucagon back then was that my doctor said, Here, take this, you'll never need it. Don't worry. And I thought when I heard that I was like, Well, there's one thing I don't need to know about right? But you really need to know about how to use your glucagon. And I learned it that day. We were very lucky to get Arden out of it with a glucose gel inside of her cheeks. But I mean, I was gonna say for the life of me but for her life I couldn't figure out

Jennifer Smith, CDE 9:50
how to and that's always a first step right. The first step is to try to get some simple sugar into the person or to be able to take it yourself But in the case that it's not going to work, and you could tell whether it's a finger stick or Now thankfully, we can see information on a CGM, then having GVL Capo pen would be a great thing to have with you.

Scott Benner 10:13
Yeah. Well, it's definitely I like you making that point. Because, you know, you don't use glucagon every day. It's, it's an emergency situation. And, you know, how do you figure out when that situation is real, especially in the beginning, before you have a lot of context for how quickly blood sugar's fall and rise? And you don't really know, you know, in the beginning, you don't really know like, did a Bolus like three hours ago lead to this is this you know, sometimes it feels like it's magical that your blood sugar is dropping and falling? Right. So let's talk about that for a couple of minutes. How do we know when to make the decision? What do you tell people?

Jennifer Smith, CDE 10:49
Yeah, that's a very good question. Well, again, as I just said, if you have treated with simple sugar, and you are following your CGM, or I always recommend trying to also do finger stick. But because we do know that CGM can lag a little bit, especially in the low blood sugar range, finger stick to be able to tell whether your glucose is coming back up. And if you are not thinking clearly enough to be able to make sense of your glucose data, then that's a time to use G Volkow pen, for example, right? Because if you don't know enough, but you know where this product is, it's better to use it. Other you know, situations for your caregivers, or the loved ones who you might have trained to use this product. Obviously, if you won't take something that somebody is offering you, that's the time for them to use this, right. And you know, all the symptoms and everything that come with hypoglycemia, some people get very angry and combative, and combative, exactly. That's don't try to feed somebody utilize this process.

Scott Benner 12:09
In a minute, I'm going to share a story that we have from more recently, which my daughter has come on the program and already shared back on another episode, but it begs repeating here for this. But for now, we have people around us, right? So not only do we need to know when to use the glucagon personally, right? If you're if you're an adult living with type one, or if you're the caregiver of someone, like wins that moment, and that moment, you know, if people are incapable taking things on their own, and they're being combative, you know, you have us you see a super low blood sugar you test and you see 20 And they can't drink or help themselves. This is the time right. It's it. Yeah, it's an emergency device. I know that's going to be a more difficult thing to decide when you're by yourself. I think I've taught Arden to err on the side of caution. Yes, she's by herself. Yes. You know, I said if you feel like you're going away, and you can't eat any type of sugar products, and things are getting confusing, you need to do it. It's in her bag that she carries with her everywhere. I have Chivo hypo pen in her side table in her dorm room. Everyone she lives with knows how to use it. The explanation we gave them and this becomes tricky because they are not diabetes mavens. Right? They don't know. No. So So we talked a little bit about Listen, insulin makes Arden's blood sugar go down. She could get confused pass out, you know, sweaty, faraway look in her face. You know, we went through a lot of ideas about how they could notice we show they all the common symptoms. Yeah, we showed her how we showed them how her her CGM works. One of the girls in the room follows Arden on a CGM. That's great. Yeah. And they know how to use her meter. Now, after so many years of diabetes, why did we go to that much trouble? Well, you know, it's because Arden had a seizure a couple of months ago before she left for college. So she's told the story on the podcast somewhere else. But I'm going to tell it to you in a brief way, because I'm really good at using insulin. And so as Arden and Arden uses an algorithm that tries to help her from getting low, and she hasn't been low like that since she was three years old. But it's still happened. And we weren't home. My wife and I were actually at my son's college graduation of all things. My daughter couldn't come with us because she had her prom. So a full day of activities, not a lot of food. I think they ate a meal at like 3am I don't think it was exactly good food that they had at 3am Her blood sugar's look terrific all day. If at two o'clock in the morning, you would have said to me Arden's going to get severely low four hours from now, I would not have believed it. Right. I just wouldn't have

Jennifer Smith, CDE 14:55
from looking at the data the way that it was and how everything had been trending thus far. You You wouldn't have expected it but there are probably a lot of variables in the picture.

Scott Benner 15:03
Well, what ended up happening was she had a meal about an hour after I finally went to sleep. She Bolus not a lot she knew not to give herself much but it was just was just too much. So, CGM beeps. My wife wakes me up. I call Arden on the phone. Hey, Arden, your blood sugar's low drink a juice, no different than any other time. She said, Okay. She drank the juice. I know she drank the juice. I said, Okay, go back to bed. And then I started getting ready for my day. And just a few minutes before it was time for me to get in the shower. Keeping in mind we're going to my son's college graduation. I think to myself, let me just look at Arden's blood sugar one more time. And I open it up and it just says low. So I call her back real quick. And she answers the phone. And I think Oh, great. And she says, Hello, but she sounded different. Like her voice sounded far away. And I said, Aren't you're low, you're really low drink another juice. And she goes, what? Am I garden? You're really low drink another juice. What? And that was it. She kept saying what I can't. What? And I know that juice was right next to her. So now I realize I'm I'm three hours away. And I know Arden's about to have a seizure. There are three of her friends, lifelong girlfriends in that living room sleeping around or on the floor. And I don't know what to do. So I scream as loud as I can into the phone. I started yelling the girls names because I tried to get Arden to say their names, but she wouldn't. She wouldn't. I was like Arden who's in the room with you. What? Who's there is Olivia there say Olivia's name. Nothing is Nadia there say Nadia name. Nothing. I knew not to say Sandra's name because she sleeps really heavy. And and so I started screaming. And then I heard Nadia stand up and say what do I do? And I said try to get her to drink a juice. So I can't see what's happening. Okay, okay, they're opening the juice up. They had switched handbags for the prom. So things were moved around. Then I hear Olivia's voice, what do I do? I say go to the drawer in the kitchen with all the diabetes supplies, get GVO Capo pen, it's in a pouch, rip the pouch open, be ready because of this juice doesn't work. You guys are going to administer this glucagon. And she's like, okay, okay. Okay. These are girls that have been around her her whole life. And if I wasn't there to talk them through it, I still don't know if they would have been okay. You know. And that's why it means so much to me to do this. And to explain to people that you, you can't just say to somebody, Hey, I have diabetes, and I might get low, but it probably won't happen. If it does and hold up the pouch and say use this, you know, you have to really make sure that they understand the significant nature of absolutely, you know, every time

Jennifer Smith, CDE 17:53
I throw one away on expiration and get the new one. I mean, my husband has heard this story so many times like this is what this is for it is right here. This is where we keep it we've always kept it in the same places. One is in the near his side nightstand and the other one is in the kitchen in the cupboard. The one in the kitchen in the cupboard is the one that comes in and out of the house with me. Whenever I'm going out, you know, biking to the park or biking around town or whatever with my boys. It goes in my backpack. My fourth grader knows exactly what it is. I've shown it to him. The little video online that actually shows pop the red cap off, push it in this part of mommy's body. No. But every time I bring it home, I go over that. Just as a review. Now that the product has changed from that old school Lily kit, right? This one being much simpler. I just go over this is where it is. This is when to use it.

Scott Benner 18:56
Now so prior to G vocab open, did your four year old know how to give you glucagon?

Jennifer Smith, CDE 19:00
Oh, my goodness. And I would have never expected I mean, I think that at this point. I think could I have trained my fourth grader on using the old school kit? I could have. They also know the other you know really important things 911 Dad's number on the phone and I our neighbors are typically on one side or the other usually always home within the daytime at least. I mean, they know some of the other really important pieces to do as well. But I don't think that I would have ever been I didn't I never trained them using the old kit. Because it's that's too much for a child of that age. In my opinion. It's it is

Scott Benner 19:47
I had trouble training adults with it. So because it's nice to say I'll be okay, but as an example during Arden's event, one of her three friends froze. Right she just froze was if it was just her, she would not have been able to help her. I mean, I maybe could have continued to talk her through it. But she was just, it's funny. And of the three of them. That's the one I thought would have been. I asked hardest. Yeah. And I got it. And instead, one of the girls who, you know, has been through some stuff in her life just sealed up and she's like, I got it. So now they're holding the hypopyon. And I said, they're like, are we gonna do this? And I'm like, is she drinking the juice? And she said, Yes. And the juice was going in and she was shaking and like elbowing the chair that she was in like, wildly. She was scratching herself with her nails from her prom. It was terrible. But she came out of it. She she had these big nails they had she had a rhinestones put on like fancy. Yeah, the rhinestone scratched her arms when she was kind of flailing around. So she started to come out of it. And we did not have to use the eyebrow pen. But it's great. We were we were it was there. I mean, I'm right. I'm like, open the package. This is it. If we don't see something in 30 seconds, we're doing this. So you know, luckily, she came out of it without it. But because of Jeevan hypo pen, I have very little doubt that one of those two girls could have done it. No trouble at all. Correct? Yeah, absolutely. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Please stay tuned for more important safety information at the end of this podcast. So then that kind of like brings us to Who do you tell? It's not just your son and your husband and your best friend who's going to be with you at your prom? You could be at a job. You could be at school, like we have. And then do you tell like you listen from my perspective? Jenny? You tell people. Correct. But do you think people do that?

Jennifer Smith, CDE 21:47
That's a really? It's a good question. I know that. My very good friends also knew at least about the old school kit. Right? They did they knew about it. Could they have used it? Maybe I took it with me to college. In fact, I had one in my backpack. I had one that stayed in my dorm room. My RA knew about it knew where it was in my room. My roommates all knew that I had diabetes. Some of them I knew previously. Some of them were brand new to me, and I just got to know them. But I don't know how many people honestly tell people I would guess that more kids and teens. Their parents tell a lot of people about using it, whether it's the school or their coaches or their PE teacher, their kids best friends that they're going to go over and have a sleepover or a birthday party at. But I think that if I had to estimate the number of people that may not tell enough people about it

Scott Benner 23:05
are adults. Yeah, that's what I'm worried about, like not wanting to tell people at work that you have diabetes even correct. Somebody's got to know, you know,

Jennifer Smith, CDE 23:12
right, right. I mean, I've had jobs in the past where I did not work within this field. Right, you know, going to college and whatnot. I mean, my, my job in high school, I worked at a PC believe this or not worked at an ice cream and candy shop. Great place. Right?

Scott Benner 23:32
That sounds good to me.

Jennifer Smith, CDE 23:33
I did I did bring my kit to work with me. My boss did know that I had it. But I don't know that I reviewed that more than one time in the whole number of years that I work there. Right. So

Scott Benner 23:51
well, I so I'm here to say I hope you tell people I hope that you get to vote hypo pan. It's you know, like you said the form factor. It's easy to carry. Tell people yes pick, please pick somebody you trust at work or at school or a teacher and make sure they know make sure. I think at high school like for example or in grade school people throughout the building. We want people throughout the building, not just one person that you know, you may or may not be with at the time,

Jennifer Smith, CDE 24:20
correct? Absolutely. And that may be you know, in grade school, middle school, you may only have a couple of people to talk to about it. But once you get to that high school age and or a college those are that's a lot of people moving around room to room classroom to classroom. You know, in college, I remember talking to each professor each semester and telling them you know, I might be eating in class because of this or if this happens, obviously, you know, call emergency and I have this thing I carry around in my backpack. This is what this is for.

Scott Benner 24:59
So you It occurs to me while we're talking. I bet you most people don't even know the process that happens after you inject the glucagon, do you think they think that what's in the pen makes your blood sugar go up? Because what really happens?

Jennifer Smith, CDE 25:14
Right? Yeah, that's Yeah, that's actually interesting consideration because I think most people probably do think that that's just, it's almost, I guess people might think that it's sort of like sugar just being pushed into the body.

Scott Benner 25:31
Right. But will you share with people what it's actually doing?

Jennifer Smith, CDE 25:34
Yeah, essentially, it's allowing your body to push out, its stored glucose sources into the body, right? It's creating enough oomph to actually bring out what your, what a normal body would typically do that, that pump and flow kind of between insulin and glucagon in the body, that helps to keep your blood sugar where it's supposed to go. So this actually helps to increase that delivery into the body and brings blood sugar up very quickly. Which is lovely.

Scott Benner 26:13
If I had to hypo pens, and I injected it into someone who was having a seizure unconscious, how long do I wait before I think, should I do it again, and is doing it again, the right thing to do? I mean, by then we've called 911, and everything, but how many times can you do it?

Jennifer Smith, CDE 26:29
By then? And I know that the typical is twice, right. So if once has not worked, that's why you get to high bullpens

Scott Benner 26:37
at a time when you get a prescription, yeah, when you get a prescription.

Jennifer Smith, CDE 26:41
So if obviously, it's also the reason that you call medical as soon as the first one is given you call 911 right away. And if the person does not come around, within about 15 minutes, then we do a second injection of G voc hypo pen.

Scott Benner 27:00
So there it is, right. We're in an emergency situation. If people can try sugary snacks or something they can I want to mention here not to force food into someone's mouth. Who's having a rancher? Because you they could aspirate. Right. Right? Yeah. So glucose gel on the cheek, you know, but if you're trying to squirt, you know, juice into someone's mouth, and it's running out the corners, you're going to choke them, you're not going to help

Jennifer Smith, CDE 27:26
them. No, right? No, that is not going to help them.

Scott Benner 27:30
So we said, we've used geolocate bullpen. And there's some steps to take, right? We're going to call 911. Correct right away, but the person needs to be rolled onto their side. Correct, okay, because,

Jennifer Smith, CDE 27:42
because the because they may vomit after the G Volk has been delivered. And essentially, it may cause some vomiting after blood sugar levels start to rise. And so you want to turn them on their side so that they don't essentially aspirate,

Scott Benner 28:01
okay. And even if you've got a Hypo pan helps the patient to wake up, we're still gonna call for 911,

Jennifer Smith, CDE 28:06
you still always just deliver it and call 911. That's what I've always told everybody, including my husband.

Scott Benner 28:15
Do we call our doctor afterwards and let them know this happened?

Jennifer Smith, CDE 28:18
Yes, absolutely. Because either it was a one time. And you you know, in your example, with Arden, you know, some of the variables that went into that, right, you have an idea that her doses are 99.9% of the time. They're right, they're doing what they're supposed to be doing. However, it's important to let your physician know, because they can also assess the data and help to evaluate and see, well, maybe there are some trends that you haven't seen yourself, and maybe some dose adjustment needs to be made. And if so, they're the ones to help you with that.

Scott Benner 28:58
So afterwards and someone wakes back up, does its job, you're awake again. You need to eat now Arden's thing like I said has even though in my heart, it felt like it took 20 minutes it was only a couple of minutes the entire thing. And finally one of her other friends woke up and I was like, Go get her some bread, something you know to eat, like something will sit in her stomach because she had had a couple of juices by then. And, and then was actually very funny because I know in the moment it wasn't funny, but going back later the one girl's like rooting around in the refrigerator. And I hear Olivia go, why are you in the refrigerator? You know they have a breadboard. We've been coming to this house for 10 years. Why are you looking for the bread in the refrigerator? She's like I'm sorry,

Jennifer Smith, CDE 29:42
I don't know I'm Oh, she was just flustered. She's

Scott Benner 29:45
like we keep the bread in the refrigerator at home so I can hear all this happening. Our artists waking up she's making sense you know, everything is okay. But you know, we got solid food into her after that.

Jennifer Smith, CDE 29:57
Right and I think an important piece To put in as well as that one low, especially a serious low such as this one. Another piece to teach is that another low could come, if you're not careful, you know, within a couple of hours are within the same day, it's very common to have a significant low and then potentially have another significant low. So it's really important, you know that you kind of lay low, right, don't go out for a 10 mile run four hours later.

Scott Benner 30:37
Maybe the rest of the day. Yes, the rest of the day is about relaxing. Well, that's what the girls did. So they had been asleep for two hours, right in the last 24 hours, and they couldn't they were all jacked up, they couldn't go back to sleep. So they just stayed awake. And it was it was I'm not gonna lie like it took more than a couple of days to bounce back from it psychologically. It was it was difficult for I'm sure

Jennifer Smith, CDE 30:57
it was absolutely.

Scott Benner 31:00
So I think you just need to, you need to be ready, you need to know what to do the people around you need to know what to do. And that's why we're doing this, about storing Jeeva Capo pen store in a sealed original foil pouch until the time of use so the pen I'm holding here would come in a pouch and the pouch actually has directions on it and they're really duds and they're good I have them here in front of me somewhere Do you have them too?

Jennifer Smith, CDE 31:22
I do the picture is very clear. Which is wonderful to see and very simple and there's not a lot of like intricate detail that makes it like you need a magnifying glass to read it but yes the directions are right on the package which makes it nice for somebody you know even though you're not going to see a needle or anything like the older kit and you may have instructed caregivers their loved ones already in that moment. It's nice to have a visual of Oh yes, I remember I do this picture I do this picture and this it's it's nice.

Scott Benner 32:00
I'm looking at it right here it's simple it says number one prepare tear open pouch on dotted line remove autoinjector pull off red cap, choose injection site and expose the skin push down on skin to start hold down for five seconds. Then the window turns red, turn the person on their side call 911

Jennifer Smith, CDE 32:18
Correct and I think you use you said something really important there expose the skin. You do not want to inject this through clothing expose the skin pull the clothes away if you have to pull somebody's pants down or pull their shirt off or whatever it is. This is necessary do not put it through the clothing

Scott Benner 32:39
I appreciate you saying that yes more about storage information so it stays in the foil pouch till time of use stored at room temperature between 68 and 77 degrees Fahrenheit or 20 to 25 degrees Celsius and you do not refrigerate or freeze it correct

Jennifer Smith, CDE 32:53
just shelf stable

Scott Benner 32:55
yes selfs just shelf stable there's just what did I just say? Jess shelf stable. That's what I tried to say yeah did not come out did it? She voc is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor starvation, chronic low blood sugar or allergy to evoke High Blood Pressure hyperglycemia and serious skin rash can occur. Call your doctor or get medical help right away. If you have a serious allergic reaction, including rash, difficulty breathing or low blood pressure. Visit Chivo glucagon.com/risk for more information. There's great information about Chivo hypo pen online. So Jeeva glucagon.com, you can use my link to vote glucagon.com forward slash juicebox Chivo glucagon.com. Forward slash risk all kinds of information. And throughout this episode I'm going to put put some of that safety information in here so people can can hear it as they're going.

Jennifer Smith, CDE 34:01
And there's a wonderful video online, just the intro video is super easy to watch. So if you physically want to, because the package is not, the package isn't clear, even though it shows you a picture of what it looks like. I think it's nice to see it being held in a hand what it actually looks like and go through the actual process. So it may be even something that you utilize. I've had a couple of parents who kind of use the video in school teaching, just to show makes Yeah, it makes it very visual when they can't have an open package because obviously you want to store it in the package.

Scott Benner 34:37
You know what after you leave me I'm going to at the end of this episode, I'll record a list of hypoglycemia symptoms. So that some case you're not in case you're listening and you're not sure. I'll go through a bunch of them for you so you can hear them there. That'd be great. Well, Jennifer, have we done it?

Jennifer Smith, CDE 34:54
I think we've done it. Yes.

Scott Benner 34:57
We're so good at this.

Jennifer Smith, CDE 34:59
Yeah, well You know, we've, we've talked often enough over the past couple of years that hopefully we would have covered things sufficiently. Yeah.

Scott Benner 35:07
Yeah. I appreciate you doing this with me very much. Because it just like I said, I, I didn't want to bring it up during the during this because it's your private stuff. But I know you've had like a low blood sugar, like through your life, and you've shared them on the podcast before. And the story you tell about, were you pregnant holding a younger child or something in a store? It's frightening to me. Oh, yeah. You know, because you're, because you're, you're so good at this. As you know what I mean? Like, that's the that's the thing, I guess I want to say to people, and I'll share this before we go. When I used to have to go into school every year and explain diabetes to Ardens. Teachers, I would tell them I'm not here explain to you everything that could go wrong, because it's definitely going to go wrong. Right. But it probably is. And when that time comes, I don't need you pulling out a piece of paper going. What do I do? What do I do? I want you to write I want you to react? Maybe it'll never happen. But I don't know. Right?

Jennifer Smith, CDE 36:08
Yeah. And if it does, then at least you have a plan and you've gone over it enough times that it's almost a second nature. Even if you've never used evoke hypo pen before you've gone over it enough that it becomes something that you plan to use. Even if you never

Scott Benner 36:26
do Yep. Danny thank you so much for doing this. Of course I'll see you soon. Sounds great. Fine. Before we go, here are some early symptoms of hypoglycemia.

Okay, some early symptoms of hypoglycemia, which of course is low blood sugar include sweating, drowsiness, dizziness, sleep disturbance, palpitations, anxiety, tremors, blurred vision, hunger, slurred speech, depressed mood, tingling in the hands, feet, lips or tongue, irritability, lightheadedness, abnormal behavior, inability to concentrate, unsteady movement, headache, or personality changes. If left untreated, these symptoms may progress to confusion, seizures, unconsciousness, and even death.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

# 385 Gvoke HypoPen

September 23, 2020Scott Benner

Gvoke is a premixed, prefilled, premeasured liquid glucagon that now comes in a HypoPen!

Ken Johnson is Senior Vice President, Clinical Development, Regulatory, Quality Assurance & Medical Affairs at Xeris. Ken is here to talk about the Gvoke HypoPen. Xeris makes Gvoke. The premixed, prefilled, premeasured liquid glucagon for treatment of very low blood sugar in adults and kids with type 1 diabetes ages two and above.

Jenny Smith is also here to help me answer questions about glucagon.

Learn more about Gvoke here

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

Scott (1s): This episode of the Juicebox podcast is brought to you by GE Voke. The world's only liquid stable Glucagon G Volk is available in our, a prefilled syringe and in an incredibly convenient to carry it an easy to use HypoPen. As a matter of fact, I have a trainer of the HypoPen right here. Let me show you how easy does to use cap comes off. I find some skin press down

1 (28s): And it's done that.

Scott (30s): Yeah. Easy to administer glucagon. It's the easiest thing I've ever seen when it comes to Glucagon hands down. We're going to talk all about it today. How the G vote Glucagon came to be or what it is, and this brand new HypoPen, which is incredibly convenient to carry. And as you just heard, super simple to administer, anybody could do this in my opinion, before I start the show, let me say thank you. Because every question and this episode came directly from listeners to the podcast. So I really appreciate the effort and the thought that you guys put into those questions. And I hope you get your answers. I think you're going to today's episode is going to be a little different than most I'm interviewing to people today about Jeeva Glucagon first.

Scott (1m 16s): I'm not even first. Now here's the surprise. Let me just give you the surprise. Jenny is on this episode. Jenny Smith is here and I'm also speaking with Ken Johnson. Now Ken is a senior vice president of Clinical. Wow. This is quite a title at here. Ken Senior vice president Clinical Development Regulatory Quality Assurance that? Medical Affairs at Xeris pharmaceutical's Xeris makes Gvoke. Ken's got to answer all of your questions and Jenny is going to answer something to me.

1 (1m 45s): You guys,

Scott (1m 46s): You love Jenny. I love Johnny. How can we not love Jenny that's who else are you going to love? Ken Ken who buy the way has the secret talent. The man could play the piano, but not have to wait all the way to the end, to find out about that. Please remember that Nothing you hear on the Juicebox Podcast should be considered advice Medical or otherwise always consult a physician before making any changes to your health care plan or becoming Bold with Insulin

Gvoke is a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above do not use if you have a specific type of adrenal or a pancreatic tumor, starvation, chronic low blood sugar, or allergy to G Voke, severe allergic reactions can occur visit Gvoke glucagon.com/brisk for more information or getting a G vote prescription has never been easier.

Scott (2m 38s): And there are two ways that you can request it through your doctor, either online or in person. If you have commercial insurance, you can request a prescription for Gvoke HypoPen right from the comfort of your home and have it delivered to your door fulfilled through PillPack by Amazon pharmacy. Just go to

dot glucagon.com to learn more. And there'll be links right here on the show notes the way now, if you'd rather go the traditional route, you can see your doctor in person and request a prescription for a limited time Xirrus is offering a $0 copay for commercially eligible patients to help insure that as many people as possible can access the vote. HypoPen okay. It's time to get to the Show.

Scott (3m 19s): We're going to start with Jenny Smith and then do a little Ken and then back too, a little Jenn. And Ken you got to get a nice rhythm going a little Jenny a little Ken is going to go just like that. I think you're going to enjoy it at the risk of repeating myself, because I say it in the episode, this is a leap for people who use Insulin making Glucagon liquid stable. It just This. If you don't understand why listen closely Jenny I already talked to Ken Johnson from Xeris pharmaceuticals about the Gvoke Glucagon and he's gonna be on the Show.

Scott (4m 7s): And just a minute, we talked a little bit just about what they were, you know, what they're trying to accomplish. I told him if the end of our conversation, that I'm incredibly excited about that company, like the ability to stabilize Glucagon in a liquid form, I think has other far reaching possibilities that I'm really excited about. But while I was talking to him, I got a it's a it's a, and can you tell if you can see this or not, but it's called their HypoPen and this is just a trainer, so it's not, it's not real, but you just pop off the cap and go like this and that's it. And it's over yet. And I was like, huh, well, that seems simple.

Scott (4m 47s): And I'm going to get one of those for Arden

Jenny Smith, CDE (4m 50s): Beyond simple. It's not scary

Scott (4m 52s): Exactly. Because you know, till this point in my life with type one, diabetes, glucagon has been a little bit of an, a, like a science experiment, but it was going to be an in a pressure situation. It's almost like someone saying to you here, do this while your driving a car, and there's a bear in the backseat, you know, you kind of felt like that to me the whole time. And, and they have their pre, they have their premixed syringes for emergencies to, which is just, you know, it's you just, it's in and push and you're done right yet. But, but still, and I'm, I'm going to ask you first, before I tell you what we do.

Scott (5m 35s): Do you carry Glucagon with you when you leave the house?

Jenny Smith, CDE (5m 40s): I don't carry Glucagon with me. If I'm just leaving the house for like going to the grocery store or going across the street to the park. No, don't I absolutely don't when we leave to go on even like a short weekend, two are in-laws or I go on, you know, to speak somewhere and whatnot. Yes. I, it with me now in that same case, though, if I'm carrying it with me in my pocket at a conference, somebody got to know what's in my pocket.

Scott (6m 9s): There's a lady on the floor. Hey, there's a science kit in your pants. What do you think? That's? What should we do? Where in the same boat, we don't carry it around like that either. If we're going to go too far away, or if it's going to be, if you're going to do at the beach or a trip, it comes with us. So here's my question. Would you carry this with you?

Jenny Smith, CDE (6m 28s): I would, because one, that's really easy to keep in my purse. And I mean, I've also, you know, knowing that I've got a son who'll be in second grade or something like this are easier to carry, I think, and from the standpoint of even teaching him visibly, there's no needle. I can easily say, Hey, pull this cap off, you know, stick it in my thigh, push it until it turns red and it clicks and it's done. I mean, that's it.

Scott (6m 58s): And it has these audio responses. I don't know if you can here the sec. So there's too, there's the push. And then the second one tells you your done. And I was like, huh, this I would put in Arden's bag. Like I really would. It's not going to scare somebody. And not only that, but if somebody opened this up a person who had no idea what they were doing, it's going to, you know, the packaging tells you what to do. And there's nothing about what I said to Ken when I was talking to him was I took this out of the mail, this trainer, and I handed it to my wife. And I said, I don't wanna tell you anything about it. See if you can make it work. And she did it right away, but it didn't take any like thought to do it's easy.

Ken Johnson (7m 39s): Hey Scott, this is Ken Johnson I'm with zeros pharmaceuticals. And I have a number of responsibilities that the company, including how we develop our drugs in the clinic and get them approved by the FDA. We also have medical team that supports ah, people with diabetes. And there are clinicians in the marketplace. And I also have a quality assurance team that makes sure that the drug's as we make them package them and ship them to pharmacy's and ultimately people and their homes meet the higher quality standards required for a prescription product. So all of those combined have been my responsibility at Xeris pharmaceuticals. For the past three years, I've been in this type of role for pharmaceutical development for a better part of 25 years.

Ken Johnson (8m 25s): I started out, I was trained as a pharmacist. I did research at the university of Colorado, whereas also involved in clinical research as a result of that clinical research. And I found my way into the pharmaceutical industry sector and had been there ever since. So that's a little bit about me. I'm I'm in Chicago where our headquarters are based and really happy to be with you today.

Scott (8m 47s): Thank you very much for doing this. I have a question about how you pull a team together for something like this. Does Paul know of you and com for you, or how does that work? Like how do you end up at Xeris?

Ken Johnson (9m 1s): Great question. So Polytech, our CEO, as someone who I met at the early part of my career. So 20 plus years ago, we were at a company based in Chicago called Searle pharmaceuticals. Paul was in charge of a number of commercial activities there and ultimately taking over some of the regional activities around the world, ah, for a number of our products. And I was his medical support. So a, you know, these things start early and have sort of an indelible effect. If these partnerships work and these collaborations work, you sort of maintain these relationships throughout your professional arc. We haven't always worked together, but oftentimes we'd been together out a couple other companies since that time. And most recently is he took the home at Cirrus who wanted to bring it together.

Ken Johnson (9m 44s): A group of folks that you felt could take us to the next level, get Gvoke HypoPen to market. And with that, he found me as well, a few others, we had this collective past together. So it's a little bit analogous to getting the band back together again. And we've, we've done that. And because of our past a familiarity success together, a what I think is an ease of collaboration, we do enjoy working together and I'm sure I'll do it again someday. Yeah.

Scott (10m 13s): How do you feel like The from the starting point to where you guys are right now, do you feel like that was on schedule went quicker than you anticipated? How much of that has to do with the, the, the, the, you know, the G Voke itself and how well it does, what it's, you know, what you're trying to, what you're trying to do.

Ken Johnson (10m 34s): Yeah. I think we encountered a situation where things were a little bit stalled or, or there's a few things that we had to take heat of that had been discovered before we arrived to make sure that we had, you know, a product that could meet all of the standards of the FDA. You could pass all the Clinical assessments. And so it really good foundation Scott, but it needed them and sort of to be rebooted to use that term it, and that meant conducting additional clinical studies further characterizing the product, making sure that we could put it into a prefilled syringe that's RPFs configuration or the HypoPen in the auto injector that was just released earlier this month. Right.

Ken Johnson (11m 15s): So that whole process of building, making testing, and then releasing brought together the team that you see today, you know, in fairness, there were about 12, 15 people at zero S when Paul took over and, you know, it's taken a lot of resources, people energy now in 200 plus employees later, you know, were on market with an approved product.

Scott (11m 40s): And for me to be sitting here holding this, this trainer pen, I guess it's a, it's a long time to get this into, get to this form and make sure it does what it says. So I think I want to understand what does it do because you've obviously come into a space where everyone has that red box and they genuinely think of it as something, you know, that they just have. They don't think much about it. I've been in that situation. My whole life. I get my daughter supplies, my daughter's supplies show up. They're there. I watch it until the expiration date and then I throw it away and I get another one. And I don't know that it's something that many people think about other than I know in the case of an emergency, you know, I've got this liquid in this powder and the syringe, and I'm supposed to mix them together and redraw them and use them.

Scott (12m 28s): And here's how, and ya know, and that kind of thing. And I have to train my school nurse to do it and, you know, My and her, grandma's got to know. So when she comes over, that's, that's, that's the narrative around that my whole life and for, for many, many people. So how do you improve on what's been going on for so long? Like what makes you feel like this is a great business and we should be doing that?

Ken Johnson (12m 52s): Well, I think, you know, just listening to your story and kind of the anxiety and complications that come with administering Glucagon for many, many years now, you know, going on in several decades of having the same configuration, it is a important pancreatic hormone Glucagon has very well known affects in terms of its ability to raise blood sugar. I think, you know, most days we're concerned about lowering blood sugar and insulin is critical, but, you know, think of this as the, the, the break where the accelerator, the, no, that the challenge is always been, it's a powder that requires reconstitution or, or, or put into a solution immediately at a time of use.

Ken Johnson (13m 37s): You can't do it early because it starts to break down very quickly. Most of the potency has lost or within 24 hours after mixing the powder for all these decades, that red box that you describe has been the single and only configuration available to people with diabetes are folks who would experience very low blood sugar. So our chief scientific officer took that on as a mission, you know, had his own personal experience and people in his life who said, you know, is it possible to overcome all those complicating, a multistep requirements of the lateralized Poudre in that vile? And he said, yeah, I think I can fix that. So it was his mission to make it a liquid, ready to use room, temperature, stable product, and to do that, we had to overcome the limitations of water and water is what you would use in the traditional kids to make it as a solution.

Ken Johnson (14m 29s): So we've taken water and replaced it with other a well known a solutions. Ours is called

. And then now that's a recognized safe, Mmm. Product is an FDA approved products and in proportion and the right steps of manufacturing, and all of our knowhow has led to being able to concentrate this Glucagon and a liquid form that you now have available in the HypoPen and the prefilled syringe. Yeah. We didn't change all the Glucagon work. Then I think maybe this conversation has a occurred as much as it could now because there's new configurations available and it's much easier to do you use an administer, but, you know, it's, it's a great solution when you have a very low blood sugar, you know, it raises blood glucose works with a glycogen that's stored in your liver, converts it into glucose very rapidly.

Ken Johnson (15m 24s): And so you have basically a, a built in system to raise your blood glucose. And as such, we, you know, we wanted to just make the process of administering very approachable, very intuitive and not intimidating. And so we think we've accomplished that, but that was all only facilitated once we had a liquid version.

Scott (15m 44s): All right. After someone uses Gvoke what happens after is, are there side effects or are there things that happen afterwards? Am I going to feel nauseous? Do I have to go to the hospital? That's also, what's your dog's name, Bailey like that?

Ken Johnson (16m 0s): The question is, so I guess, I guess we'll have to give her a credit today. So a couple of things, I mean, you know, the effect that you do want is to raise a blood glucose, and that happens very quickly as we start to see changes in the blood glucose concentration within the first five minutes of administering the product is raised to what we consider a safe level of blood glucose very quickly on average, about 14, 15 minutes. And then the duration of action is probably about 90 minutes or so. So you have this ability to sort of bring yourself back up and then have it come back down, right? So it's a, it's a temporary fix two. What was a scary as hell? What can happen?

Ken Johnson (16m 40s): Glucagon has some other effects has some effects directly on the gastrointestinal tract. And so it at about 30% of the subjects that are trials has some nausea and about 10% handsome vomiting. So those are 10 or 15%, and those are kind of the hallmark features of what Glucagon does not matter what too, to anyone that sensitive to those GI side effects, importantly, they are transient. They are mild 80% of the people in our study and characterize them as mild. They went away and in our case, no one actually stopped being in our study because they had that, that known side effect that you would see that Scott with the old movie got, and you would see it with our Glucagon a you'll see it with future Glucagon so that we haven't mitigated.

Ken Johnson (17m 30s): It's probably dose-related. I think, you know, there will be a Day I hope someday where if we, you know, use different doses for different purposes, that we can mitigate some of that nausea, vomiting, but for the rescue one milligram setting of use your gonna have, in some cases, nausea and vomiting, then those side effects are

Scott (17m 50s): Side effects of Glucagon do not have a specific brand. It's just what happens during the process of bringing that low blood sugar up so quickly through Glucagon.

Ken Johnson (18m 0s): Yeah. And it may not even be read to get your rights. That's, that's the correct way to describe it in event, not even be related to the blood glucose, going back up as much as it is. There is a known, in fact that Glucagon to slow down the action of your GI tract so much. So that is completely different from what we're talking about today, but a radiologist will actually use this drug to stop someone's GI tract from moving, if they need to do procedures and other things. So now this is one of those situations where a bad thing for some person is a good thing for another, but it is important to let people know that there is some mild nausea in about 30% of people who use it for, for rescue.

Scott (18m 41s): Can you help me understand the different ways that I can administer as you vote when, you know, when you guys first came out and I became aware of You, my daughter switched too it, and she has the, the prefilled syringe, but now I'm holding. Like I said, This this dummy pen. That to me feels like I'm like what people would consider an epi pen and to be, I, I, I just push it down on my leg and hold it there for a second and, or a couple of seconds in, and I pulled away. Why do you have different versions? And can you tell me the difference between them?

Ken Johnson (19m 16s): Sure. The Glucagon it's the same for both a Gvoke PFS are people terrains in G Voke, HypoPen in the auto injector, you're holding a, in your hand. And so there's no difference. And that the active ingredient, the solution, the concentration is identical. It was a simpler and more straightforward manufacturing process to come to market with the prefilled syringe. It's less mechanical requirements because you, as a person, are the person helping you is actually going to do the injection much like you would self-inject or Jeff Insulin. Right? So it's a small subcutaneous injection, the necessary requirements to then put that into a device that fires itself, the auto injector, umm, it's more complicated, more engineering.

Ken Johnson (20m 7s): And we wanted to make sure we had sufficient quantity. So we come to market like we did the Smith and not having a sense of shortages or, or, or running out to be able to supply to market adequately. So, umm, there's a really, really high specification for performance of that auto injector because you're no longer responsible for pressing the plunger and the mechanics inside the auto injector. Our and so the FDA has carefully scrutinized the performance of this device and it has to work 99.99, 9% of the time. So that's a manufacturing spec and it came out of the experience that we've all had with epinephrin and HypoPen we want to make darn sure that if someone's going to pull that red cap off and press that yellow plunger, that if a fire's and so that took us a little more time.

Ken Johnson (20m 57s): Both were approved last September and in 2019, we could bring a prefilled syringe to market immediately and then to deal with all the issues that I just laid out. We just need a little more time and happy to release that now in July,

Scott (21m 12s): That's exciting. It really, it really is terrific. As I'm sitting here holding it, I mean the, the leap and leap really is the only word from what I'm accustomed to, to this it's it's like they're not even the same species in a, to B to be honest, it's a, it's a great, a great advancement. So I mean, whoever that guy is, you figured out how to make that, that liquid stable stuff is, is brilliant. Hey, have you ever used the Glucagon Isn't working on everything she's like, so the reason I asked is because while, while we were talking about this, he said, you know, we, we were talking about people administering it at themselves and I'm trying to think, I wish really trying to picture like, where's the tipping point where you're, it's gotta be, you know, it's not going to be one of those like, Oh, I got a little low, I need to eat something.

Scott (22m 10s): Obviously that's that's first, but there's probably a moment where you, I'm guessing, you know, imagine you're on a CGM and you see, you have double arrows down in your 50 a and you think, you know, you do the math real quick and you think, Oh my God, I gave myself too much. Insulin I can't catch this, do this like this. Right. Yeah. That made a lot of sense to me. I I've definitely been in situations where I thought, I don't know if I'm going to stop this with food and you know, and that's for Arden, but I really thinking about adults living by themselves. Okay. Can I have a question that I heard you say a second ago you were talking about self-injection and I think that there are many people who might assume that Glucagon has only for when you are having a seizure or an unconscious, but how would I self inject if I'm having a seizure or unconscious?

Scott (23m 4s): So obviously that's not the only time to use it with when are the times I'm supposed to be using this or, or I'm able to.

Ken Johnson (23m 11s): Yeah, I think that that's a great discussion. Thanks for raising that point. So I think, you know, there are a number of settings. Everybody has their own personal experience with what they deem very low blood sugar. I think you, in some of your colleagues have taught me this phrase, the, I don't know, low. Right? And so when that happens, it could be because you are looking at your numbers, it could be because you start to feel differently. And you know, some of the sort of classic signs and symptoms are, you are shaking. You're dizzy, you confused, maybe you haven't changed your personality or, or more combative, you know, trouble answering questions. Those sorts of things are all kind of hallmark sciences I'm going low.

Ken Johnson (23m 52s): So when that starts to happen, of course, the first rule of thumb is try to correct it with food or drink, right in your favorites. A source of glucose for many, many decades now has been referred to you as the 15, 15 rule, you know, take those 15 grams and the 15 minutes and see if it's work, if you're improving. So that's one situation maybe that isn't working and it's a stubborn lo and you know, you're starting to now wonder what's next. So that would be a time to consider administering Glucagon. And I think most people would not have reached some state of incapacitation where if they were familiar and able to a administered the auto injector where the prefilled syringe, they can, there are other settings where people are unwilling or unable to swallow or to have enough, you know, stuff available.

Ken Johnson (24m 43s): Maybe there a place where they don't even have access to a source of glucose. That would be another situation. If you feel like your passing out and there's somebody with you, obviously you'd want them to be able to administer it so that the community discussion, he should know the other people in your life, be familiar with where, with the gun it is and how to administer it. As you pointed out this HypoPen auto injector, it's a super intuitive and the instructions are printed, write on the pouch. And so I think if somebody found you and you said, you know what to use it, you know, it's going to be very straightforward process. We have tested that and found that in simulation exercises where someone is going through simulation or of an emergency in a very low blood sugar, they were able to administer correctly 99% of the time, follow the directions and do the two step process that you just talked about.

Scott (25m 34s): When the, when the trainer arrived at my house, I took it out of the packaging, took the instructions away from it. I handed it to my wife and said, I told her what it was. And I said, don't even think about it, try to use it. And it didn't take her 10 seconds to figure out what to do with it. And nobody here has ever used, you know, an epi pen or anything like that. So we've never held her or seen anything like this before. And I made me feel like, I hope my insurance company will cover a bunch of them or spread them all over. Arden was a college experience when she leaves for school. For me, I'll just, I'll just put one everywhere. It just really was intuitive. Is the word for it. It's you can't look at it and hold it and like eat.

Scott (26m 16s): There's no other thing to do with it. I don't know if that makes sense or not. You know what I mean? Like it feels like there's just one way to accomplish something and it, and it shows you that while you're holding it, like you said, it's in the instructions, but I'm seeing when you have the physical things in your hand, it's not like there's seven levers and you've got to decide which one it is. It only does one thing. And then, you know, if it does it well then perfect.

Ken Johnson (26m 37s): You know, I think, you know, that was part of the design, the understanding there's a whole area of science, human factors, research the services. How do we approach? So to solve a problem. And, you know, there's very, very intentional features built into that auto injector. The colors are intentional, the little window that you have that shows the liquid Glucagon, you know, in there. And it disappears. It turns red when the dos has been delivered, that's intentional. The clicks that you hear, those are intentional to let you know the sort of audio queue that the cycle it has been completed. We also have safety built in when you finish the injection and withdraw the plunger from the bare skin, it locks out.

Ken Johnson (27m 19s): And so you cannot have a needle stick because there is a needle inside the device, but it's, you know, never appears during the process of the injection. And when you're finished is locked out. So you can't have an accidental needle stick. Can I ask

Scott (27m 32s): Where can, can you just inject it? I mean, anywhere, like where has it, where did you, where were you able to get the FDA approval? And how do I remember that when I'm going low? Like, you know, or is it just anywhere I can get it into me is good.

Ken Johnson (27m 47s): And we, we concentrated on three areas, thigh, abdomen, and your upper arm. So we figured out, in most cases, one of those is going to be readily accessible. If you do have to have bare skin, because we want to make sure, you know, this is a 27 gauge needle. We want to make sure that there's nothing sort of inhibiting its path as it goes into the skin. But you know, we, in our assessment, Scott, most people opted for the abdomen. I think it was probably an easy to just pull your shirt up. And most people have an adequate real estate there. So, you know,

Scott (28m 20s): If I'm going to say I'm okay, I don't, I might all need Glucagon, but I'm a, but I definitely have a place to inject it. So,

Ken Johnson (28m 27s): So, so any, any of those three sites and it didn't matter, you know, the results, the clinical changes that we saw were the same, regardless of psych.

Scott (28m 35s): Well, that's even, that's very exciting because like I said, for people who know about older products, it's a, we were always taught, you know, deepest part of the buttocks, you know, like it's a, it's a big needle, you know, it's a, it's not an exciting, not an exciting endeavor for certain. So even that's a huge leap is my insurance got to pay for this. How do I, I mean, that, that's part of your purview, right? When you were talking earlier about what it is, you're a, you've done in the past. And so you, I'm assuming you have some background on this. You can talk about it a little bit. Yeah, I do.

Ken Johnson (29m 10s): If you know, and you never want to have a drug approved, but then not have any access for people. And so, you know, that's an important contribution that the company had to make in terms of going to insurance companies, going to pharmaceutical benefits management companies, you know, very close to the time of our approval last September and have these discussions about why it would be so critical to be able to offer this new a much easier, much more approachable version of Glucagon and the one they have been covering. So there wasn't any restriction on your Read KIS. And so we ask, can you give us the same treatment? And I'm happy to report as we sit here today for a commercially insured individuals, if you have unrestricted coverage at 87% of plans in the United States.

Ken Johnson (29m 54s): So almost 90%, wow. That, you know, why isn't it a hundred, there's no product that ever has a hundred. So there's always some small portion where there's going to be additional requirements. So that would mean that you would probably still have a copay and everybody's plans are different. These can be very, but you won't get one of these not covered types of messages. And the 87% of covered lives in the United States for commercial insurance. If you look at Medicare, probably the next biggest segment for people with diabetes, who should have Glucagon is about 80%. And then we're still working our way through the Medicaid requirements and were about four to 30% on Medicaid.

Ken Johnson (30m 37s): So if you know, for most folks, your not gonna have any significant access issues in terms of affordability, we are right now, if you go to glucagon.com, you can get all the details on a copay assistance program. And the net effect of that Scott is you would have a $0 out of pocket for the HypoPen for the, for the present time. So we're, we're starting out the launch of the product, offering that additional support, which means if you say had a $30 copay and you qualify it for the program, the company would subsidize at $30. He is essentially received it for free.

Scott (31m 15s): That's excellent. A great what was the,

Ken Johnson (31m 17s): The webinars Gvoke glucagon.com. It's GV. Okay. Now I've had a few people say, gosh, how do you pronounce that? But a GV. Okay, look again on.com.

Scott (31m 29s): Glucagon.com. I got it. And I'll put it in the show notes so people can find it too. So if someone's using a different Glucagon right now, and they've heard you on Thank I'm would like to try this, do they wait to their next appointment, go to their doctor and say, I want to switch my Glucagon are, or what are the pathways to making the change?

Ken Johnson (31m 49s): Yeah, I think any of those might work. I think traditionally, when we need something new, we would contact her in health care provider and se there's a new Glucagon and it's called Gvoke HypoPen. Can you send me a prescription for that? Can I get a film, our experience with clinicians if they are pretty well aware now, but this is a configuration that's on the market. We've been working hard with a professional society's and through their channels to make sure that they know that as a personal Diabetes requested that they would, you know, no of it and not be afraid to read the prescription because have the access issues. Now you have also been cleared that makes it very easy for them. So it's not very cumbersome if you don't want to pursue it that way and just make a call to the doctor's office, usually does not require a visit.

Ken Johnson (32m 34s): Scott it's just a, you know, a new script is an issue from the electronic system. You can pick it up. That's your favorite pharmacy. You can also go to the website and we've set up some services. They're a little bit more analogous to kind of ordering online and you can enter some personal information or information about your doctor. And we have support services available now through pill pack and Amazon company that will work with your doctor in deliver it to your home at no cost.

Scott (33m 5s): I'm not sure I heard you, right. Is it PillPack?

Ken Johnson (33m 8s): Yeah. So the Jenny that helps assist in sort of the transactional part of this is PillPack. It's an animal Amazon company. A but the easiest thing to do is to go to

glucagon.com and start that process. And you'll see, you know, the sort of order entry information is there for those instances where you would just say, you know, it might be easier to start and do this on your own, but, but either way at this is not an area where, you know, the standard of practice has been to make sure that people had Insulin or other drugs that cause severe low blood sugar, I should have Glucagon. And so is not a difficult conversation. And clinicians, I think, are actually relieved to know that you care and want to have, have this tool,

Scott (33m 50s): Right? So if someone listening just feels that economically they can't do this, they should be able to and contacting you is the way to go.

Ken Johnson (34m 1s): It is. And I think Listen, there are, there could always be some leg and whether or not the coverage policy has caught up and maybe their getting a strange answer about how much their out-of-pocket would be and things like that. We have a whole assistance program in place to help navigate that. We know how frustrating that is, you know, we wanted to make Glucagon easy to use, and now we want to make getting a prescription filled, easy to do. So, you know, we have very, a nice set of services that are linked to the website. There's also a phone number at the website. And in case it's easier just to call and talk to a real human, but you know, that takes you through a whole tiered process of, you know, is it going to be covered?

Ken Johnson (34m 42s): You know, what pharmacies have it and so on and then write down to even, so the patient assistance programs for folks who can't afford their medication,

Scott (34m 53s): The concept of having to mix Glucagon stopped us from using Glucagon when Arden was legitimately having a seizure. I just don't know that. I mean, you know, technology's better now, obviously, and that's great, but I don't see, I can't imagine going backwards on this one, like this to me seems like the best it's available. Right. I was wondering, do you hear from people about mixing and what did they, what are the responses? Do you think that that having to mix the Glucagon stops people from even considering it as an option? Sometimes

Ken Johnson (35m 33s): I think given that that was all of that, there was all that was available

Jenny Smith, CDE (35m 39s): For such a long time. I mean, you know, again, thankfully my parents never had to deal with that. They never had to mix it. They never had two. It was always there. He always knew where it was in the house, but I, I would say that it's certainly a deterrent to use because it's, there are just the extra steps, again, as you brought up in your situation, it's like having to think through those steps when you got your loved one, either having a seizure or you've discovered them completely like not with it at all out, can't talk to them, whatever your brain is thinking in terms of helping them.

Jenny Smith, CDE (36m 24s): Yes. But all the steps of mixing, making sure it was mixed right now, you've got in the needle on that. I mean, this is scary looking needle, compare it to a syringe needle for Insulin. It is, it's a bigger needle, right? So, you know, imagine putting that into your two year old or even your 12 year old child and knowing that you're doing it the right way. And I can say that it would be a it's a deterrent, although I dunno, in the case of not having anything else as an option, you figure it out, but it's certainly going to be,

Scott (36m 58s): Well, I have a friend who recently had a teenage son, a have a seizure and she got the red box out. She got it mixed. And when she went to draw it back out, like in the, what your describing, running upstairs, people yelling, she broke the needle off in that crazy. So they had to go to a secondary option, but they were getting ready to use it. And she, she was trying to traverse there's and mixed Glucagon at the same time she was running to where it was happening, you know? And I think, I just think that that's the point, is that anything that simplifies that is genius and putting it in, you know, what can be described to people who don't know any different?

Scott (37m 44s): Is it as an epi pen style? Like just this thing in your hand that you just push down and hold this, turns it into something people can carry with them.

Jenny Smith, CDE (37m 52s): Absolutely. I even think two from a school type setting, even the comfort level of, let's say for some reason, you know, technology is down your not able to contact the parent. You don't know exactly what to do. I mean, from the standpoint of safety and feeling okay, and teachers or the Peros or whoever's helping at school, this is a hundred percent easier.

Scott (38m 17s): I think this takes away from that thing that a lot of people who aren't, who know, who have kids know, you go to school and you're like, I need somebody to be a Glucagon advocate from my kid. And everybody's like, no, thank you. You know? Like, like they really do too, like teachers, or like, I don't want to be on the hook for this, but, but this is like, again, I think this takes away the possibility that they can make a misstep in the middle, like drunk when Arden was a little, her, her directions were drawn up half the vile. You should have saw the fear that put on someone's face. Well, how do I measure half of the vile? I'm like, I don't know. I bought it. And they're like, what? I'm like, Oh, here we go. This is fine. After I get either the prefilled syringe or the HypoPen, how long do they last until they need to be replaced?

Ken Johnson (39m 4s): Yeah, that was part of our design criteria. We didn't just want to make a liquid ready to use if you wanted to make sure it could last a long time because you know, hopefully once or twice a year event and most, and even if it's a never event, you know, let's do not have to replace it too often. So right now, from the time of manufacture to the end of life or a potency, a sufficient for a re restarting, the blood glucose it's two years, but it's a very long shelf life. You know, we, again, you know, that was part of the design process and certification process and approval with the FDA that we have a two year from time to a manufacturer expiration.

Ken Johnson (39m 46s): So that'd be printed on that other product. You'll know when it expires a number of pharmacies. Now you can have reminder programs. So, you know, it's time to get at all.

Scott (39m 54s): Can I have to tell you? And I genuinely mean this. I've spoken to a lot of people who work for peop you know, manufacturers of different drugs and devices, and that's the first time anyone's ever said anything to me that almost knocked me off of my chair. I just took two years. Is it's amazing. And not what I expected you to say. That's because what I was going to say is, you know, we got the prefilled syringe, and I had a question about that actually, before I go down my story, we got the prefilled syringe and it comes in sort of a pillow bag is my best description of it. And my first thought was, huh, there's a needle in there. And this is sort of a bag. And then when I reached out to the people who are listening to the podcast, that was actually a question they had was, you know, why does the like, explain to me why the, the needle is safe in this bag?

Scott (40m 41s): And I guess, I guess thinking couldn't it be deployed, but to answer that for me first, obviously you didn't make something and not think, Oh, I wonder, you know, I'm assuming it's been tested, but explain to me how you came to the, the packaging for the prefilled syringe.

Ken Johnson (40m 56s): Yeah. It serves to a number of purposes. The packaging is a sealed foil pouch. Its done a very, a controlled environment. The prefilled syringe that if you describe Scott actually has a noodle shield on it and also has a backstop to keep the plunger from being deployed. So why a pouch? I think you started with that question. So first of all, the instructions are printed on the pouch and we want to make sure because you know, the real estate on a, on a prefilled syringe where the real estate and the auto injector is not sufficient to describe how to use it. It would be six point font and we wouldn't be able to read it. We have these very clear pictures and words printed right on a pouch that could tell anyone how to use it.

Ken Johnson (41m 42s): In fact, we tested that we have people who are untrained in the administration of the prefilled syringe and the auto injector and they successfully administered it. You know, like I said before, 99% of the time. So the second is that foil and the gas that we pack it in inside there. Cause you notice its like a pillow because its actually has a pressurized it's in there helps with and moisture because those are the enemies of any drunk. It doesn't matter if it's Glucagon or anything else sort of protecting it from light and moisture helps contribute to that two year shelf life. So we, we can't stress enough that you should keep it in these pouches until the time you use what people are.

Ken Johnson (42m 25s): You know, people may say, well, it's, here's how I know what to do. What's inside the pouch. So that's why we've provided videos. That's how it could be provided the demonstration units. Like the, when you have, you know, they'll be available in the clinics. Doctors have been requesting those demonstration units. So if there should be no mystery about what's inside the pouch, but we do acid if he started in that until the time of use and it's, you know, so multifold purposes for having that pouch

Scott (42m 52s): Is it all makes sense. It just, and had, I probably thought about it longer, you know, what it really is is that it was just different and so than what I was accustomed to. So when I saw it different felt wrong and now you explain it to me and like, Oh, well different seems like more well thought out in a new and better. So a that's excellent. Can I give you

Ken Johnson (43m 11s): If you want to anecdote as we were testing that power and sort of the size of it and how big the print was and everything else, we've had a number of Diabetes educators as a part of our forum for focus groups. And there was some that wanted it even bigger because they wanted to write all kinds of instructions and the margins and the doctor's phone number and you know, reminders about other things and stuff. That's like at some point we had to say, no, you know, we can't add to it, this giant pouch, it's gotta be small enough and portable enough. So, so, you know, there, there were a few rounds of the things that, you know, let us to the current configuration,

Scott (43m 41s): If they did, they have it up to the size where you could put three holes in it and people get carried around in their binders.

Ken Johnson (43m 47s): They're, you know, so, so know is all intentional and a contributes to the, the long shelf life. It contributes to the successfully administering it and at the time of emergency and it also protects the product

Scott (44m 1s): Going back to the beginning of this thought for me, what I was getting ready to say, when I asked you how long does the product last before it needs to be replaced? What I was gonna say as I think I'm going to get to move on to the HypoPen afterwards, because I can see how, you know, it's just, it would just make, I think this would be easy to show my daughter and say, look, if you really feel like you're in trouble, do this. And it wouldn't feel like, you know, a rigmarole I guess, and, and, and maybe off putting in any way. And so I thought I'll switch, but now I realize I've gotta wait two years. I switched. So a, I M

Ken Johnson (44m 34s): You bet you brought up another issue and that is keep people, staged them at different parts of their daily life. Right? If you keep the prefilled syringe and the nightstand at home, you might have the auto injector at school or with the coaches or wherever. So, I mean, you know, mix and match again. There's no difference that in the Glucagon is contained any of their device for the product.

Scott (44m 55s): No, no, no. I, I, and I, I guess I was half kidding, but I do know that, you know, there are different Podcasts if our kids ever grow back to school, she'll need one for school in, in a couple of other places. And it just, you know, I can't, I can't say it enough, it's the, it's easy to have you on the show and talk about it. Because like I said, this is a leap and this is going to make people's lives. I think easier if they should ever have an emergency and need to use it. And I think the comfort they're going to get from it, just having it around Is is going to be different. I, you know, I really don't mean to pile on somebody, but that, that red box is not comforting. It's off putting, and this, this thing I'm holding this pen here is comforting. So there's a lot to that.

Scott (45m 35s): There's a lot to the psychological, the psychological side of all this. And I appreciate that. That was considered,

Ken Johnson (45m 42s): You know, we've talked with folks sort of who lived through all of this and seeing the changes in technology and new delivery. Insulin certainly advanced and the bringing forward CGM pumps are, you know, all these things have been stepwise improvements. Glucagon just, wasn't tackled. And, and, and now that we have, you know, we want to keep making improvements and exploring other other uses for it and beyond the, the, the currently approved one. And so the companies, you know, vested in making the most of a liquid ready to use Glucagon. And so, you know, stay tuned for more. Now

Scott (46m 20s): That as I was jumping on this call, I got a message from somebody. It was so funny. They don't know the timing of my schedule, but they just were like, if you, if you haven't spoken to the people at chief Oak, yeah. Can you please ask, is there a water and Insulin and if there's water and insulin can, can, Insulin be made more stable with their technology. And I was like, I dunno, I'll find out. So I, maybe my bigger question is, are there other things your stabilizing over there, or, or you just the Glucagon company, or is there more,

Ken Johnson (46m 54s): You know, we are more than a, Glucagon a company. So at our core, we want to take the technology to make liquid ready, to use easily injectable, very stable products and all of the areas where it makes sense. We have talked about it Insulin and it's a, it is a project and it's not anything that's a, you know, advanced in terms of it's Clinical Development. But we do recognize that there are limitations on the storage conditions for Insulin or other things that it can be mixed with cost problems. So maybe we can start to combine it with other effective, low blood glucose agents and make a better combination. So, umm, the, the short answer is yes, we can apply our technology to a broad range of drugs, proteins, monoclonal, antibodies, vaccines.

Ken Johnson (47m 42s): And so, you know, that's, our mission is to take all of the concern and the difficulties of administering and storing and drug out of the equation. And so that's, that's kind of the, the future state of zero S and, and how we'll apply ourselves. But you know, us now as the blue thing, as a company first and foremost, and a, you know, and we'll use that as a starting point and grow from there,

Scott (48m 5s): Your technology applies to a lot of other things. So they're, there are probably many things that we can't talk about that are being considered there. And I'm asking that question as a wink and a nod to all the people who asked me questions that are not covered by your FDA approval. So I can't ask you here, but they'll all understand where they hear this and be excited that you're working on other things I think is that fair?

Ken Johnson (48m 28s): Oh, that's definitely fair. And our company website to a separate from a DeVos glucagon.com describes some of our pipeline and the things that are still in an experimental phase. And you'll see that it's, Glucagon, it's a drug called die as a pan for seizures in other programs. So we're, you know, we're, we're really interested in applying this technology broadly and solving problems for patients and their providers,

Scott (48m 55s): If it's possible that I'll ever be able to get G Voke in a vial for home use to just keep and administer as I need

Ken Johnson (49m 4s): What we would like to pursue that. Yes, I think, you know, there are a number of applications of Glucagon that are different than our are approved used today. It's a one milligram, you deliver the whole dose, a in the setting of restoring very low blood sugar, but there are other settings where maybe the smaller dose would be useful. And, and so there or other settings, whether it's exercise, whether it's hypoglycemia, unawareness, other things were, there are a series of, you know, Clinical Development projects that we've sponsored. We've collaborated with one side as well as a part of a dual hormone delivery with Insulin and Glucagon as part of a closed loop system.

Ken Johnson (49m 45s): So in a, none of these are approved, none of them are a possible with the current configuration. We would need a vile of Glucagon as you describe the Scott. So it'd be very similar to how you would administer Insulin. He would have personalized doses for the situation that your trying to manage. So that's gonna take us some time, but we are investing in those efforts, you know, just ask everybody to stay tuned for more.

Scott (50m 10s): All right, well, I'll say this from my heart and many people may or may not understand this. And I guess if you've been around Diabetes long enough, if it makes sense, but it may not seem super exciting that someone figured out a way to make Glucagon liquid stable, but is super exciting and that it opens many doorways and possibilities for the future. Everyone who has someone that they love with type one diabetes or has type one diabetes, should be incredibly jacked up and excited that you guys figured this out. And I know that it, it's hard to wrap your head around why this is that exciting, but it is. And I'm, I'm very much looking forward to what happens next. So I really appreciate you coming on and explaining all of this.

Scott (50m 52s): And I thank you for your time, unless you want to play some piano. I think we're good.

Ken Johnson (50m 57s): My pleasure. Scott I enjoyed it and hopefully we can do it again sometime. And my best to Bailey you left the room,

Scott (51m 8s): Dammit, cameo bark. So you'll have to cut that part. So I thought I could get a little park at the end and we'd be finished anyway. Thanks so much. Enjoy the rest of your day. Really appreciate your time. All right. Appreciate it by huge. Thanks to G vote for sponsoring this episode and for giving me the opportunity to just speak with Ken and a huge thank you to Jenny Smith for being such a good friend and coming on the show to talk about Gvoke. If you'd like to find out more about you Vogue, there are links right here in the show notes of your podcast player@juiceboxpodcast.com or you can just type the words

glucagon.com in to any browser to learn more about the company that makes you Vogue go to xeris.com X E R I S P H a R M a.com.

Scott (52m 1s): I have a little bonus stuff here at the end for you. If you'd like to keep listening, I actually spoke to Ken the day before we recorded this just for a few minutes, so we could get to know each other. And he told me about his piano playing. So I brought it up at the beginning of this recording while we were getting the audio set up. So it was recorded, but not really a part of the episode, but I left it here. Cause it's interesting. What kind of music do you apply? So,

Ken Johnson (52m 28s): Oh, I'm like what they prefer to, I guess, as a professional journeymen, sidemen I'll play whatever, whatever comes on my way, I read music, you know, I play from classical to jazz, to tribute acts, including pink Floyd and van Morrison and a REIT, the Franklin and two classic wedding bans. You know, the most cliche kind of lounge music. You can imagine it doesn't really matter a musical theater,

Scott (52m 55s): The multiple instruments or not.

Ken Johnson (52m 58s): I'm a piano player, keyboard player.

Scott (52m 59s): That's really, that's an amazing skill to have. That is very cool. And it's great that you get to do it too.

Ken Johnson (53m 5s): Yeah. So Chicago, you know, traditionally has been famous for lots and lots of live music. And of course, many famous bands have come outta here, but we're a complete shutdown now. It's just awful.

Scott (53m 18s): And online really doesn't replicate it. There's been, I think one or two people who have done it well, you know, and it's, you know, you have to, you can see how much money you have to have a, in a crazy example is that, I don't know if you saw, you may not like this kind of music, but maybe you do. You mentioned pink. Floyd Metallica did an old song acoustically remotely. So all four guys were in a different place, but it sounds like it was recorded in a studio. So you have to assume that each one of them has a professional recording studio in their home, you know, but that worked out, but,

Ken Johnson (53m 51s): And that's exactly how they do it. And what we are led to understand as consumers is they record all those tracks independent of each other, and then somebody who mixes them because you can't, you can't use zoom to have simultaneous music because whoever's talking to the loudest takes over the channel. And so there's, there's no mixing up on zoom. It's a, it's a big problem.

Scott (54m 12s): You know, all that equipment and the willingness to spend a couple of million dollars to mix a song together to release it. And they had that money and they did it. And everyone else is just like you said, fumbling through trying to do in a resume for those of you who are not familiar with a podcast and don't know who Jenny Smith Is I thought I'd take a second to let you know Jenny is a frequent guest of the show. She's helped me put together series within the Podcast like defining Diabetes, ask Scott and Jenny. And of course, the very popular Diabetes pro tip episodes and of all of the people I could have had on those episodes with me. Here's why I picked Jenny. Jennifer Smith has had type one diabetes for over 30 years since she was a child.

Scott (54m 53s): She holds a bachelor's degree in human nutrition and biology from the university of Wisconsin. She is a registered and licensed dietician, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. I love Jenny. She is a friend. And when I decided to do this episode, I asked her if she could help out a little bit and she was very gracious and said, yes, Jenny works, has integrated Diabetes so you can check her out. If you do, like@integrateddiabetes.com.

# 324 Gvoke Glucagon

April 13, 2020Scott Benner

Gvoke is a premixed, prefilled, premeasured liquid glucagon

Paul Edick is here to talk about his path to becoming the CEO of Xeris. Xeris makes Gvoke. The premixed, prefilled, premeasured liquid glucagon for treatment of very low blood sugar in adults and kids with type 1 diabetes ages two and above.

Learn more about Gvoke here

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of The Juicebox Podcast is sponsored by GE Volk, the world's only liquid stable glucagon. g vocus. a prescription injection for the treatment of very low blood sugar in adults and kids with diabetes ages two and above. Do not use if you have a specific type of adrenal or pancreatic tumor, starvation, or chronic low blood sugar. Side effects may include nausea, hypoglycemia, vomiting, headache, hyperglycemia, and injection sites swelling, itching and stomach pain. Being prepared is always important, but right now it is at the forefront of all of our minds. Did you know stress in erratic schedules can increase the risk of scary lows. g Vogue prefilled syringe is the first liquid glucagon that is pre mixed prefilled m pre measured so it's ready to go. If you need g vote PFS and can't physically get to your doctor's office, there's still a way to get it. You can request a prescription online and pharmacist at pillpack by Amazon pharmacy will reach out to your doctor for a prescription. They will then ship your G vote PFS to your home at no additional cost, just the cost of your copay. Please note at this time, this option is available for people with commercial insurance only. You can learn more including a link to the important safety information about g vote pfs@www.ge Volk glucagon.com, forward slash ordering dash g Volk, it might be hard to remember. So I'll put a link in the show notes.

When I first suggested that Paul, come on the show, I didn't know anything about his history. So I started at the beginning, asking him how did you get involved in this kind of work? And the answer took us on our ride that I just did not expect. I really found it fascinating to pick through someone's life and see where they started and what they thought they were going to do and find out about some of their first jobs that have, you know, seemingly nothing to do with what they end up doing. So sit back and relax. And we're gonna find out how a young boy from New York ends up being the CEO of the company that brings the world's first liquid stable glucagon to market. A glucagon that is pre mixed, pre measured and ready to go. It's kind of fascinating. One last thing, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, and to always consult a physician before making any changes to your health care plan. Yeah, there was just like, there is like air behind you. And it's like, oh, god sounds like you were on the highway.

Paul Edick 2:51
Well, so where our building is located. We're surrounded by train tracks. Well, we're on the 16th floor. But you might hear some train noise in the background. Don't worry, a

Scott Benner 3:07
fighter jet will fly past Dexcom once in a while when I'm speaking with them. adds a little flavor.

Paul Edick 3:14
Well, we chose to put our office close to the train station. So everybody could have an easy commute. So it's a nice idea comes with its

Scott Benner 3:23
Can you take credit for that? Or Where was it? Not your idea? And you just take credit for it? Oh, no.

Paul Edick 3:29
I've done it in two companies now is very purposeful. Okay. very purposeful. Yeah, we promise everybody will be within four blocks of a train and train station or l stop.

Scott Benner 3:38
That's really excellent. That is and you guys are located in Chicago.

Paul Edick 3:42
Downtown. We were one block south of the river on the sale. Nice

Scott Benner 3:47
is that and by the way, we are recording already.

Paul Edick 3:56
I'm Paul edic. I'm the CEO of zeros pharmaceuticals.

Scott Benner 4:01
Obviously, we're just talking as we picked up the column, Paul didn't know we were recording but now that he knows we can just kind of keep going. It's funny now that you said that I want to go in a direction. And I guess I just Well, are you. Not a young man? Paul? Not right out of college, I'm guessing.

Paul Edick 4:18
No, I've been in the pharmaceutical business. This is my 41st year, but I just turned 64 in July. Okay. All right. I've been doing this a long time.

Scott Benner 4:28
So things that other people may not think about, like I'm gonna put a building up and we're gonna get a company rolling and it should be near transportations, so that hardworking people don't then have to schlep home and get you know, like and cause problems for them. That's the stuff you learn over time, I imagine.

Paul Edick 4:44
Yeah. You so if you a lot of companies they locate in office parks in the suburbs, and people are landlocked and there's no real energy. It's just in the building. We you know, I look in the suburbs, and there's all the normal land, you know, buildings. But when you come into the city you can locate in buildings where it's vibrant, there's a lot going on, there are people and movement and energy. And the commute is actually shorter by train for most people than driving two buildings in an office park in the suburb. So it, it helps with the energy of the company. But it also makes it easier for people and therefore you attract people better.

Scott Benner 5:31
I'm incredibly interested about how it gets set up. But I guess I have to, I have to go backwards before I can jump into forwards. So let's start slow. Where did you grow up?

Paul Edick 5:41
I grew up, excuse me in a small town in, in a dairy dairy country in upstate New York. So for for people who are in New York City, upstate New York is Poughkeepsie. I grew up about two hours north of Syracuse, just just a little bit before the St. Lawrence Seaway. very rural, very small. What did your parents do? When I was a little kid, my dad was worked in a Chicago pneumatic, which was a tooling company. My mom worked in a shoe factory.

Scott Benner 6:17
I asked because, you know, growing up in a small town that's, you know, pretty removed from what I would think of is big business. And coming from, you know, your parents doing what they did. And I think of myself, and I always used to say to people, like, it's hard to imagine something other than what you know, you know, what I mean? Like, I know, you know, like, I know, people who want to be professional athletes, but when you look at them, they grew up around a professional athlete. So it seemed like a reasonable thing when I was young, I wanted to write, but that didn't seem like a viable way to make a living because the people I lived around were, you know, kind of hard working blue collar people. And I don't think that writing something seemed like a, you know, a reasonable way to make a living. So I, so I'm fascinated about how you made it from there. To here. I wonder, did it happen in high school or not till college? Where did you start thinking about business? Are we just trying to get out of a small town or how are you feeling?

Paul Edick 7:10
Yeah, great question. I started as a little little kid in Central New York. And then we moved to this town called la ville, in upstate New York, after my dad, finally, he got a degree out of Syracuse University became a teacher. My mom was able to get out of the shoe factory, became a secretary. All I, I you know, in terms of aspirations, from a career perspective, I don't really recall having any I think my aspiration was to do better than my parents. I grew up in a second generation, Italian immigrant family. You know, my mom couldn't speak English. When she started grammar school, I was an athlete. And I had opportunities to go to college for free and a lot of places around the country because of athletics. And I was a pretty good student. But I ended up going to a small, private college called Hamilton College, Central New York. And coming out of Hamilton, it was time to get a job. And I, I interview on campus got a job with Procter and Gamble, my entry into the pharmaceutical businesses, accidental, to say the least

Scott Benner 8:23
yet see, it's interesting, because you're describing You know, I'm, I'm 48. So I'm not of your generation, but I'm probably not too far along, but my parents definitely had that vibe about them the idea that you were just trying to do a little better tomorrow than you did today. And and kind of get get through it. There was no grandiose ideas like this is the thing I'm going to be one day you're just like, I need to get up in the morning, go to school, learn something, go to college, learn something, get a job in that. It's funny how I don't think people now think like that as much like I think they have plans for themselves and ideas.

Paul Edick 8:58
Oh, no question. No question. Every every, every kid I talked to wherever young person I talked to, you know, how do I get to Xyz? And, you know, the first thing I say to say to people is keep your head down, do your job and the rest will take care of itself.

Scott Benner 9:15
Yeah, I'm always amused by my wife will tell this great story about she hired this person. And after 30 days, they came to her very earnestly and asked when they'd be getting a raise. And you don't even understand what the job is yet. You've only been here for 30 days. She said, I've never been late. and was like, well keep keep you keep that up. Okay, thanks. I get out of here. And she's like, I she came home and she's like, 26 year old person doesn't really even understand what our job is yet. Once a race once and I was like, Yeah, good luck. No, that is that's, that's really excellent. So yeah, so your parents weren't as much. They were immigrants more than that, like so I say. It's funny. I applied. by today's standards too, and I just assumed like, that's the job they had. But they were working their way up as well.

Paul Edick 10:05
Yeah, my grandparents came over, you know, on the proverbial boat from Italy, right, my mom was born in the States. But in those days, they lived in an Italian community in a small town. And they spoke Italian, interestingly enough. And we always tell these stories, but my parents, my grandparents refused to speak Italian around us kids, because they lived in a world where they were discriminated against. They didn't want us to speak that language or even have an accent. You know, fast forward to when we're teenagers and adults. And we're kicking ourselves that we don't have two languages.

Scott Benner 10:50
Right. I mean, that's is how things have changed. But there's there's a safety idea more than anything, like they probably saw it as an impediment to your success if people thought of you as an immigrant.

Paul Edick 11:01
Correct. And assimilation. Yeah, right. There was a, it was an absolute drive to become and to assimilate that. It was fascinating.

Scott Benner 11:09
That's excellent. It's really, it's fascinating, because I don't think that we, I just don't think we talk about this a lot anymore. And this is really what our conversation today is about is trying to figure out how you got to where you are now and what your what your focus was. So you're saying, and I don't think this is uncommon at all, but in college, what did you major in first,

Paul Edick 11:30
I would started my freshman year as a pre med student. I had done, you know, National Honor Society, the whole nine yards in high school. So I had great grades. I was also a two sport athlete in college was a little bit different than I my very first semester, I got a C in calculus. So I was done as a pre med student. And so I, I switched to psychology.

Scott Benner 11:57
Paul's smartest kid and his class up there in New York didn't didn't shake out as well.

Paul Edick 12:03
Well, it was it was interesting. The biggest reason I got a C in calculus was because I was still using a slide rule. And if you even know what that is, if people and most of the kids in class had moved on to calculators, the very first Texas Instruments calculator, my parents couldn't afford it. I was still using a slide rule, and I didn't finish most of the tests on time.

Scott Benner 12:34
Okay. That's Yeah,

Paul Edick 12:36
so it wasn't for lack of knowing information. That was I couldn't get it done. Yeah. the right tools.

Scott Benner 12:42
Right. Yeah. That's so interesting. How many letters home said I need a calculator? Or did did your Paul Yeah.

Paul Edick 12:48
No, that was one that was one conversation that didn't go very well.

Scott Benner 12:55
Paul, did you ask for a calculator? And then your mom told you about being born in America? First generation Italian? No, I got the Don't you have a job and can't you work more hours that interesting. You know, My son is a sophomore in college right now. And he goes to a similar type of school. Actually, Hamilton is one of the schools he tried to let you know, he reached to. And so he's in a similarly sized school. He likes a smaller school, he wanted liberal arts. He didn't quite know what he wanted to do yet. And when I asked him about helping out he says that his job is good grades in baseball. I'm now I mean, yeah, I could put him on the phone with your mother.

Paul Edick 13:34
was interesting, you know, to make not to belabor the point, but I had offers for four year full scholarships to three or four different big time universities for sports. I chose to go to Hamilton College, which is division three, and they couldn't, it was non scholarship. So I actually had to pay to go to college. Yeah. And that was a decision I made that don't from my parent's perspective. Okay, well, you got to pay for it. Right? Because they sure as heck couldn't. Yeah,

Scott Benner 14:05
no kidding. I do think that my son Cole did the same thing. He that he had opportunities to go play baseball places that were, in all honesty, just schools where you would have played baseball, you come out with some sort of a degree, but I don't know how great it would have been. And he said, I'm too good of a student for that. I have to go somewhere and get a get like a real solid education. That's like Okay, great. Yeah, get over there. But the same thing, you know, there's not quite as much in the way of offering of money when you when you make that decision. Exactly. Okay, Paul, so you're in college, you're you're kind of jumping around finding your major and everything and finding your level really like looking for where you fit and where you're good. And did you find Did you fall into business at that point, or did you finish with a more of a mathematics track? How did you handle it?

Paul Edick 14:49
No, I actually, I moved to psychology. I was fascinated by learning and memory. I actually did you know, my sophomores sophomore in junior years. did research and learning and memory, so not behavioral psychology but more the learning aspect of psychology. I loved it. And my research was actually published. And I graduated with a liberal arts degree. You know, I took a bunch of other courses, took a lot of religion courses, political science, you know, you had to take statistics if you're a psychology major, so liberal arts degree, and then I started interviewing for jobs on campus. Interestingly, because of the research I was doing, I was getting extra credit. I finished in three and a half years, I was one of the few people that was available to be hired in the spring. Because I wasn't going to school anymore. And I got a job with Procter and Gamble as a sales rep in their case food division.

Scott Benner 15:44
So that's something you just use thin the herd by being available sooner.

Paul Edick 15:49
Yeah. And because I was doing independent study during the summers, got extra credit. And I was done.

Scott Benner 15:56
Okay, that's interesting. So should you head off to Procter and Gamble as a young man? What was your expectation that day where they hired you? And you were probably out of your mind excited? Did you even know why you were going there? what you were doing or were you just like, this is a job.

Paul Edick 16:11
You hit the nail on the head. It was a job I, you know, I didn't know who Procter and Gamble was. I learned who they were. It was, you know, great training and all that. But I, big company, and I had a sales job. And it was, you know, in upstate New York, Albany, actually, Saratoga Springs, what were you selling? I was calling on grocery store managers. Selling Duncan Hines cake mix, Crisco shortening, Pringles potato chips, the original Pringles potato chips, the red wooden in the can that basically tasted like cardboard. And, you know, in grocery store managers, you know, like I said, everybody, they come in two flavors. They're either 65 and about the pinnacle of their career since they were 21. Or they're 21. And they're going to be at the pinnacle of their career until they're 65. I mean, grocery store managers, that's a life. And they grocery stores work on such small margins. If you're making 3% margin as a grocery store, you're doing pretty well. So they're intense. Its intense. It was great training, you know, I learned how to sell

Scott Benner 17:24
and how to read people talk to them.

Paul Edick 17:27
Well, you you very quickly have to understand their needs versus yours. You learn very quickly, if you if you're not really attuned to their needs, and how their store works and what they are trying to do. They won't even talk to you. Because they, they they are focused. It makes me want to ask you a personal question. Are you married? Y'all? Yes, yeah, for a long time. I'm on my second in both of them for a long time. My first marriage was 17 years and this marriage has been 18 years actually good for you. And I bet you, you stay out of trouble, largely in what

Scott Benner 18:06
I'm reading the signals and I know what to say now because I need you to buy some shortening from me. And

Paul Edick 18:11
yeah, yeah. Well, Crisco shortening. Yeah, it was. It was fascinating. It was interesting. I you know, but that's, that's how I, I accidentally ended up in the pharmaceutical business. I was in a grocery store, one of the first stores that actually had a pharmacy, it was an experimental store in upstate New York. And I was talking to the store manager about putting Pringles a big end to end tower of Pringles with beer next to it. And showing him how much profit he was going to make and how it was going to sell. And I was going to put a big sign up above it and all that. And there was a guy standing in the corner, watching me and it was a little disconcerting. So I didn't know you had a suit on and tie. And afterwards, he comes up to me says, you know, I'm from Johnson and Johnson, I'm from ortho pharmaceutical. We're looking for great salespeople. And he gave me his card and said, I'd like you to talk to my boss. And like, I don't know, three, four weeks later, I was working for j&j in the pharmaceutical business. Okay. You know,

Scott Benner 19:16
it's interesting. That's the that's the sales version of the somebody seeing you in the mall and going here. So pretty. Have you ever considered being a mom?

Paul Edick 19:24
Yeah. I don't, I didn't get that.

Scott Benner 19:29
I've just, it's interesting. And was that odd? In the moment? Even then, were you just like, wow, this is a strange situation.

Paul Edick 19:35
It was but it was. It was. It was an opportunity of a lifetime. It was Johnson and Johnson. Remember, I came from a little bitty town in upstate New York where, you know, in a county where there are more cows and there are people actually working working for Procter and Gamble. And now I'm going to go work for j&j. j&j was the most respected company in the world at that time. Right

Scott Benner 19:58
now you would open a medicine cabinet. I imagine they made almost everything and yeah and beyond.

Paul Edick 20:04
So it was it was the opportunity of a lifetime. It's excellent.

Scott Benner 20:07
I have to tell you that, you know, as you and I were getting ready to speak, it kept running through my head, how do you become a CEO? Because I kept thinking, that's not something a kid from high school says to himself, like, I'm gonna go to college and become a CEO. You know, I'm going to run a company, I'm going to make all of the decisions, everything is going to filter through me like that. I mean, if you were thinking that when you were 12, or 13, you probably had a mental illness, and they wouldn't filtered you out by that. Yeah. A little too great. Thoughts for a small child. And so there's no CEO track in college, there's no. And I thought, I wonder if this man's not going to tell me a story of, you know, finding something, doing it well, moving to something else, seeing something jumping around, it's so interesting. This is the way I look at my my wife sometimes. And I realized that where she is, was never once on purpose. You know, she just took a job because she needed a job. And she did her best and someone noticed, and it bothered. And it just kept going. And I wonder how many people actually have similar stories like that?

Paul Edick 21:04
Well, that's what I said earlier, I, you know, I just keep, as a younger person, I just kept my head down and did my job. And you might I was lucky, I work for people who they, you know, you do your job, they take care of you. So I never had to ask for a raise. I never had to ask for a promotion. I did my job and those opportunities presented themselves because I was in an environment where that's the culture, you take care of the people who are performing. I moved up in that company, and then, you know,

Scott Benner 21:42
you foster that. Now, when you're in charge. Is that is that a culture that you try to keep moving? Because I think some people would hear that as generational, but I don't think it is. I think it's, I think it's cultural. What a company.

Paul Edick 21:52
Yeah, it's very much cultural. And it's something that we foster a great deal. Over the years I've, I've taken from every company I've worked for, and every job I've had and different opportunities. It's funny, you say, I'm going to be a CEO, I'm gonna make the decisions that when you're CEO, he very seldom actually make decisions, if you're a good one, because you should have an organization that decisions are made at the level that they're that's appropriate. If If you end up if I end up in a situation where people are saying, well, we got to see what Paul thinks before we do that. It's like that's, we're about to fail. I find out about a lot of decisions. And because of the culture that we foster, and that I Foster, nine out of 10 decisions are usually pretty good ones. Yeah.

Scott Benner 22:40
Now it's it's funny you made me I'm from Philadelphia originally made me think of the Super Bowl a couple of years ago, where there's that great tape of the the quarterback running over to the head coach of the Eagles in a incredibly intense scoring possible situation. They just goes, you want to run this play. And the coach goes, Yeah, sure, go run that toy. And it was just like, it was just wow, he trusts him. He knows what he's thinking. It's amazing. You know, and, and I so I take your point?

Paul Edick 23:04
Well, trust is

I'm not a believer that trust is earned I, if I hire somebody that means I've, I believe that they're the right person, and I'm going to trust them. You can only lose trust in my world.

So I just think it's a different approach.

Scott Benner 23:27
g Volk is an easy to use pre mixed prefilled pre measured liquid glucagon, all you have to do is open the foil pouch, and inject it. Joke does not require refrigeration. It's available in two doses for kids and adults. And there's a simple two step process to administer it. I have seen a seizure from low blood sugar and take it from me, it is a harrowing moment. What you need in that situation more than anything is something reliable. That's easy to use. It doesn't require a ton of steps, because that is a you guys have heard me talk about on the podcast before but it is a crazy situation when someone is having a seizure and you feel like you're what stands between them and further harm. You want something that just works. And evoke is that thing, open the pouch, inject the glucagon, you did it. To learn more about g vote, go to G vote glucagon.com forward slash juicebox. But you get to that link, you can actually order g vote right now today through pillpack. Or you can take some time to understand what g Volk is. So the next time you go to your doctor, you can tell them I'd like to use this glucagon, it's premix. It's prefilled. I think it's going to be easier for me to use. I've read up on it. It's definitely what I want. You'll have some confidence when you go to the doctor, you'll know what you're talking about. So go to the link, check it out. Make yourself familiar with what Evoque is. Then you can decide if it's right for you. Arden I just made the switch at her last endocrinologist appointment. And I think if you take a look, you might want to do the same g vogue.com forward slash juice box with links in your show notes, or Juicebox podcast.com. To find out more about the world's first pre mixed prefilled, liquid stable glucagon. Let's get back to Paul, to find out about the rest of his crazy whirlwind life. I think it's opposite of what most people do. I think most people come in cynical and say, you know, you go ahead, show me. And if you're saying, look, I tried, you know, I saw you, I believe in what you'd said to me now go ahead and do it. That's, um, I think that's the way you build?

Paul Edick 25:48
Yeah, well, we have, like I said, I have taken from a lot of companies in this company, and to some degree in my previous company, but in this company more than any, we, we have one sheet of paper, it's got four boxes, and it's got a series of behaviors in each box. And what I've said is, if we can, if we can behave this way, we will build a great company we can be proud of. And if we do that, and serve our customer, well, in the process, we'll, we'll have a great company will be very successful. You know, we don't have goals that are about dollars, we have goals that are about the kind of company we're going to build the way in which we're going to serve the customer, and then all that other stuff will happen.

Scott Benner 26:38
Yeah. Now I talked to people a lot about management of diabetes and use of insulin. And everyone always wants to know, like, tell me what to do, like, Where do I how much do I use? When do I use it? How do I get my agency to come down? Like, it's always very point on it, and I tell them constantly, that's not what you want to be doing. You need to find the tools, the right tools, learn how to use them, and then all the things that you want will just happen. And you won't even have to, you know, wring your hands every three months. Like I hope my agency I hope isn't, you know, just it just sort of happens when you're using the right tools. It's so

Paul Edick 27:13
right. It's so fast about behavior. Yeah, the behaviors,

Scott Benner 27:17
the basics of most success in any kind of situation. They're all really very similar. Yeah, it's, that's really cool. So I see you're a J and J. You're young man, you've been plucked out of the grocery store. Probably smelling like pastrami and pretty happy this guy found you. And did you just go right into sales again at j&j?

Paul Edick 27:41
Yeah, I was a sales rep in the territory then, you know, sales trainer than a district manager in Chicago and a regional manager out in San Francisco. I was there for like 12 years, I left j&j. And went to Baxter, actually, was a good move.

Scott Benner 27:58
interesting how this happens, because I see this happen a lot to see you gain a lot of broad experience with a large company. And then suddenly, to a smaller company. You're You're like the hive mind. You've seen every little, little corner of the business and you kind of have experience in a lot of different places.

Paul Edick 28:16
Yeah, well, it was a I went to it was a Bachelor's of Medical Products Company fairly big years ago. It was a combination of Baxter and American Hospital supply once upon a time. But I was actually in a small division. So I didn't have any didn't really have the answers yet, because I went from selling pharmaceuticals detailing direct doctors about drugs to a division of axure that was called caremark at the time. caremark at that point in time was a home infusion therapy company, which means that you, instead of putting a patient in the hospital to get an IV, IV antibiotics, for example, okay, you send a nurse to the home and you do it in the home. But that business, you actually run it, you're running kind of like a hospital without walls. You take the assignment of benefits for a patient, you bill and collect on their behalf, you do the therapy, you do everything.

Scott Benner 29:13
You just don't have a structure that they come to

Paul Edick 29:15
correct. And in the learning, I learned how that health, I learned how the healthcare business actually work by by being in a service business, as opposed to just selling drugs. And then I took a detour from there, I met a gentleman who had an advertising agency in the pharmaceutical healthcare business. And he said, I got a lot of really good advertising people. I've got a lot of marketing people, but I don't know have anybody in my company that understands how pharmaceutical companies and medical products companies work. I actually went to work in that advertising agency for a few years, launching drugs all around the world and you coaching, and consulting with clients on how the healthcare business actually worked. In back then that was in the late 80s, early 90s. It was the advent of managed care, in what companies didn't realize is they weren't managing care, they were managing money. And it was, it was all about the, you know, the movement of money in health care. So if you understand what they're trying to do, you know, as a hospital from a financial perspective, then you understand how your services and or products fit into their world better.

Scott Benner 30:40
When you look today at healthcare, do you and you look at your job? Do you see that, you know, you talked earlier about when you're in sales, you have to understand what the needs are of the of the person buying? So now, I'm assuming you need to understand not only the needs of your customers, and what what they require from you, but you have to understand how to navigate the healthcare world? And do you? Do you find yourself just saying, I'm going to get in this canoe? And I know how to get through this these rapids? Or do you try to reshape the rapids at the same time? Like, how much of that? Do you see is your responsibility to move things? in the right direction for the future? And for versus, or maybe not versus but for the patients?

Paul Edick 31:26
Yeah, that's a great question over the last two decades, what I've come to believe, is that with intense focus on the patient, that's the only way you're going to truly navigate what's going on in healthcare. Because the controlling factors of health care delivery, to a larger and larger degree are all about money and less about care. And, you know, having been in you know, big pharma, and then in small companies, and, you know, started a couple of companies, I, my focus is on, if I'm going to do something, if I'm going to build a company, it's going to be around products that can change healthcare for the better products that can positively impact patients lives, potentially save lives, and reduce their overall cost of care. If I can't do those three things, I don't want to do it. Because it just the world of healthcare right now. It's just too difficult to do anything. Otherwise,

Scott Benner 32:33
I had no idea what you were gonna say, the conversation led itself there. And I realized, as you were speaking a moment ago, the only reason you're on the podcast, is because that's the vibe I got from the people you hired, who reached out to me originally. And, and I get, I get pinged a lot by a lot of people, and they're like, you know, they wouldn't be on the podcast or buy an ad and most of them I turned down. And that's because, to me, the podcast isn't about making money. The podcast is about serving the listeners so they can live, you know, healthier lives with Type One Diabetes. So I only really let people in who I have that experience with. And it's, um, it's just fascinating because you and I really haven't spoken before this, that my vibe of what was going on at your company is is really your goal. And so it's, it's completely obvious, you know, to Oh, absolutely. It's very, very interesting and satisfying for me actually, just a moment like when you were speaking I thought who I was right about this guy, thank god

Paul Edick 33:36
Well, that's good to hear. It's an important part of it. It's critical. I you know, I wouldn't be doing this if I couldn't do that. I, you know, I came out of retirement to do this. And it's about like I said, it's about building a great company that people can be proud of. And in that the word greatness comes from the ability to do everything I just said how

Scott Benner 33:58
did that how does that happen to your retired retired like sitting at home on the patio retired or just in between jobs and not in a hurry to get another one? How, what was the situation?

Paul Edick 34:08
No, two years retired, I was retired, retired, I had been approached about numerous companies and CEO positions and I wasn't terribly interested. Two of my former one of my former investors and another investor that I knew well from the world of healthcare investing, called me, and then they reached out to me through a third party to say please just come talk to us come look at this company. This is little bitty group of people. They've got this cool technology, and it needs a reboot and you know,

Scott Benner 34:43
so as a favor, I I spent some time evaluating what Cirrus was at that time. And so you just sort of came in and consulted a little bit saw the the landscape and we're thinking maybe you'd help them in a certain direction or give him some pointers, but then You ended up staying?

Paul Edick 35:02
Well, no, not not consulting, I just was, I was doing diligence. I was looking at it, you know, to say, Okay, what is the substance of the technology? What can it do? But is it well protected from an intellectual property perspective? Can Can you really build drugs around it. And what I found was, was fascinating, you know, very simple, yet elegant technology in terms of formulating taking old drugs that are not stable in solution, and formulating them into liquid stable products that are way more useful for patients. In many different therapeutic areas. The very first area we're in is the world of diabetes, and, you know, hypoglycemia, but the technology can go in a lot of places. And I saw the opportunity to build a company. There were a lot of people in the Chicagoland area that were, I thought would enjoy coming back together and working together again. So I said in truth be told, I spent about a month as demo three or four months evaluating and then I spent one month building a new plan for the company. And I presented it to the board of directors and said, you know, here's the plan. And here's how much money that's going to take if you're on board with the plan, and you're willing to either put in or allow me to go raise the money necessary. Here's the company we're going to build. And they said, Absolutely. In fact, funny story, I kept saying, well, but we'd need this and we need that we need that. And they kept saying yes, so at a certain point, I couldn't say no.

Unknown Speaker 36:42
Maybe, maybe I can, maybe I could talk them out.

Paul Edick 36:46
If I throw enough stuff in front of them, they slowly fade out. I launched a drug once upon a time called Celebrex. Are you familiar with

Scott Benner 36:54
ever heard of that? Of course.

Paul Edick 36:56
So Celebrex before to bring that drug to market, I think was somewhere on the order of $1.2 billion

Scott Benner 37:05
just to get it out the door

Paul Edick 37:07
before the first capsule was ever sold.

Scott Benner 37:11
So what do you do? You just put it next to beer so that people say

Unknown Speaker 37:18
I wish it was that easy.

Unknown Speaker 37:20
If you Paul's got a brilliant sales plan, if you need glucagon, that's a liquid stable. It'll be at the beer store right next to the Miller.

Scott Benner 37:29
Well, I'm sure you've I'm sure you'll adapt your thoughts. But that's Yeah. Can I ask you What about? Because let me be, like blunt for a second. You guys are making a really boring drug. It's just it's the inside of the diabetes world. It's not something you hear people clamoring about, right? Like it's not. I don't know what I mean. It's not sexy. Like, oh, it's a CGM that tells me which way my budget is moving or great insulin that does. You're talking about something that I think most people think of as that red box, it sits in my drawer, I never use it goes bad. And I throw it away or donate it to my kids school so they can learn how to mix the powder with the liquid like, yeah, and and having heard your life experience. I'm interested in what you saw that in those few months, when you were there looking that made you think this is something that people need, and this will be successful?

Paul Edick 38:22
Yeah, that's a great question. Because most people would look at it and say it's boring. First and foremost. There are five and a half million people in the United States taking insulin every day. The vast majority of them at some point, sometime somehow, sooner or later, are going to have a serious hypoglycemia that requires rescue. I look at that. And I say, Oh my god, the current form factor is almost impossible to use. Only about 20% of those people actually have glucagon when almost all of them should have it. Then you look at it and say over 27,000 people die of severe hyperglycemia every year in this country. totally unnecessary, totally unnecessary. Over 250,000 emergency room hospitalizations for severe hypoglycemia every year. totally unnecessary. And the cost associated with all of that. totally unnecessary. When if you could build a better glucagon, one that is liquid, stable, ready to use, you know, you can keep it in your nightstand, you can keep it you know, in your backpack. It's like if you look at allergies, you know, severe allergies, a fraction of like maybe five to 7000 deaths a year

Scott Benner 39:52
because of epi pens

Paul Edick 39:54
because of the advent of a useful product Right, an epinephrine product that's easy to use, easy to administer, stable at room temperature, etc, you're saving lives. You are reducing costs, you're making it a lot more convenient for people. Why wouldn't you do that? And the thing that's even more interesting, if you look at the diabetes community, the general consensus, the education that's happened, where physicians are saying, well, you should you know, you shouldn't use glucagon to your pass out, which is totally wrong. You should use glucagon before you pass out. You know, people always say, Well, you know, why can't you just use juice boxes and glucose tabs? It's like, yeah, okay, absolutely do all that. When those don't work. When you are at the point of I don't know what's going to happen next. a two step convenient. take the cap off, give yourself a shot to glue gun is a life saving experience. Yep.

Scott Benner 40:55
Paul, I have to tell you from, from my perspective, what you're saying resonates because, you know, I can give you some examples. So my daughter's 15. Now she's had type one diabetes, since she was two, when she was first diagnosed, we got into a situation where we just gave her too much insulin, we didn't know what we were doing yet. She had a full on seizure. She was, you know, incoherent and grunting and, you know, couldn't see and talk and everything. And I and I am, I've told this story a number of times before, it was one of the reasons why it was comfortable having you on because I knew when I told it to you, that people who listened would know that I wasn't just saying this, because you were here, we're laying on the floor, you know, sitting on the floor of my daughter's on the floor, my wife is working on glucose gel trying to get it open, and I'm holding glucagon. And in that moment, I could not for the life of me remember what anyone told me about reconstituting it. I didn't know. And I and I couldn't do it. And we brought her out of the seizure another way because we just couldn't, I couldn't figure it out. And when it was all over, and I had time to reflect on it. What I remembered most is that when someone handed it to me initially, they said, Oh, this is glucagon. It's in case you get incredibly low. It's like a life saving thing. You'll never need it. And as soon as they said that, I guess my brain just went, Oh, we'll never need this. And I just think so much was going on in our life, I did not really have the bandwidth to start learning things I didn't need, you know, and so I just didn't it. It's funny, even when you go to explain it to somebody, you're like, hey, well, you know, you take this. So there's this powder in this vial here. And then there's this liquid in the syringe, you want to take the liquid chute. And as you're doing it, you're like, Oh my God, if this ever happens, this babysitter is not gonna figure this out. And moreover, and probably most importantly, we don't carry it with us. It's not, it's not Yeah, doesn't lend itself to something you keep with you. And and I'm excited for something that does it and and that's, that's what you saw when you went down there that days, you saw you saw the the future of what this could all be.

Paul Edick 43:02
Yeah, and I did quite a bit of research. And I went out, I actually went out and talked to doctors, I went out and talked to patients who were you know, diabetics and said, you know, how do you do this. And I remember my grandmother was a diabetic and I remember my mother giving her shots. And but I, you know, I don't even think I don't even know if there was such an glucagon even existed at that time. But the, I just tried to I went out and listened, and said, Oh, my god, there's a, in my mind at the time, there's a critical need here, there. And, and the, the community doesn't understand that there they could be, there could be something better. For me, it was back to what I said before, an opportunity to change the way medicine is practiced, and opportunity to save lives. And in doing so, the net net is going to be less cost to the system.

Scott Benner 43:57
He said the company's been in existence for how long?

Paul Edick 44:01
Because the company was started by the Chief Scientist as almost, you know, like skunkworks in his back, you know, his, his workshop years ago, like 10 years ago. The company, as it's constituted today, you know, really starting to do serious research and putting products into development, probably about five or six years.

Scott Benner 44:30
The initial scientist, you know what led him or her to work on this.

Paul Edick 44:36
He's our chief scientist today, Steve Petroski. He, he was in a company where he was a formulation chemist, formulation scientist working on different kinds of things. And he you know, one of his areas of interest was products that are not stable in solution or not soluble and he developed Have a an approach chemistry where he can put liquids which are not water based into a formulation, get the water out. And in so doing, you create a much more stable product it can, it can, it's fine at room temperature for like two years. And there's a lot of products that require reconstitution, that, that mixing piece that you're talking about, where you've got a powder, and you've got a liquid and you mix it up, and then you've got the drug that you're going to administer. When that's a water based solution. It usually is not stable when it's in solution. So it degrades very quickly. So, you know, if you could take that kit that you describe and mix it up, and have it in the syringe and carry it around for a couple years. I think you'd find that, you know, a lot more of those five and a half million diabetics would actually have glucagon on hand. I think so too, and and I wouldn't have to be buying them over and over again, as they expired. Right. And, you know, it's interesting, people say, Well, you know, I don't know if I'll use it. And I said, Well, I'll tell you, when people will have severe allergies, my grandson, you know, six epipens. When they when they're expired, they go by six more.

Scott Benner 46:23
Because it's not, it's not the, the constant, you're not going to use it all the time. But it's that one time that you better be prepared for I had somebody the other night, a physician, who said, Well, you know, I've I've only had to use glucagon place in my life. And I was done. I said, so glucagon saved your life twice? Why wouldn't you get one of these better devices? So you have it on your person? It's interesting, fair, interesting, the way they think about it, I completely agree with you. I think it's like, you know, it's like car insurance, almost like you're not planning on hitting somebody. But, you know, the day it happens, you know, for whatever reason, and I talked about it in diabetes that way, as well, as, you know, the idea of, if you could plan for when something was going to go wrong, then it would never go wrong. You know, like if you know,

Paul Edick 47:14
yeah, what you went through as a parent, parents, parents should never have to go through?

Scott Benner 47:21
Well, I have to tell you, it's one of the worst moments of my life like hands down, it really, it's up there in my top 10. I wish these this didn't happen to me, it's experienced that I could have gone my whole existence without having. And I'm even liking the idea that Arden could keep one on her. In the other setup, it doesn't really lend itself like anybody can figure out how to just, you know, push the plunger, but the rest of it is off putting. And then you you also have to keep in mind that that process needs to be simplified, because it's possible that while you a you know, as a bystander, or a friend or a parent is trying to figure this out, there's a person who you know, or love having a seizure, that that could be the situation that that makes thinking a lot harder I can tell you from from experience, you know, you're not you think you're like all comical. I remember afterwards, I said to my wife, like, I think I handled that pretty well. And she's like, oh, you're out of your mind, you don't even know. And I was like, She's like, yeah, you weren't doing well, at all, in case you're wondering, I thought I was you know,

Paul Edick 48:24
it, it is a rare individual. It's a rare individual that is calm in a crisis. I mean, you know, there are very few people that in a crisis, they go to a place that is very calm, very deliberate.

That's not your normal, that's not your average human being. I like

Scott Benner 48:42
the idea of anything that takes away steps or need to think or, you know, possibility of dropping something or that any of all that is better. And I'll tell you why. Not that this isn't incredibly exciting. But as you were speaking, what I really heard was this process that your lead scientists came up with has other applications.

Paul Edick 49:03
Oh, absolutely. We were building better drugs in two or three other therapeutic areas as we speak.

Scott Benner 49:11
It's excellent. That's very cool. Well, I have a ton of questions for you, that are more nuts and bolts, but I think we're out of time, honestly. So either I'm going to get you to come back at some point, or I'm going to have whoever you think is the best person to talk to about the real, you know, the real use strategies behind it. And, and there's part of me that really wants to ask you about closed loop systems, but I'm assuming you're a publicly traded company, you're gonna like shoo away my question. So I'm not asking you about that. Unless you unless you want to talk about it, Paul.

Paul Edick 49:42
We will have the only liquid stable glucagon. So if there's a system that works, we've we've now what you now have not to take too much time but what you now have is the real innovation here is a liquid stable glucagon. You can use it in all kinds of ways. Not just Rescue. So if somebody can perfect a two hormone pump system, it needs glucagon and insulin. Now you finally have the only liquid stable glucagon. So we'll see how the, we'll see how it all evolves. If you're building

Scott Benner 50:17
one of those systems, head over to Chicago, look for the building that says Pringles on it. And that's, that's a little B, can I ask you? And if you can't say I understand, but I'm assuming right now that your FDA clearance for an emergency situation? Are you planning on trying for a therapeutic? Like, you know, instead of injecting the entirety of the dose, if say, I was just in a situation where I had the flu, and my blood sugar was stuck at 50. And it just kind of wouldn't move? And I want to put in a tiny bit of the product, would it? Is there? Are you thinking about that over there?

Paul Edick 50:54
We're testing it in all of those applications. So if you're if you want to exercise, you have to go through an incredible process to not have your glucose go too low. We're in clinical studies on using glucagon our glucagon in small doses before. Exercise. We're studying our glucagon in continuous infusion for people who don't recognize their hypoglycemia symptoms, that you know, that's the classic person who is one minute just fine the next minute in a car accident. You can reboot with continuous infusion of glucagon for about a month, we believe you can reboot the system we're studying in non these are not diabetic, post bariatric surgery, people get severe hyperglycemia after certain kinds of meals. We believe by using a little bit of glucagon after that meal, you can prevent severe hypoglycemia. So we've got a research project going on there. Like I said, with liquid stable glucagon, you can address a multitude of other conditions. And like you said, you know, what is mini dosing? How does that work? Can you? Can you give yourself a little bit of good gun for different things? We're studying it. We have four clinical programs ongoing right now. That's,

Scott Benner 52:21
that's very encouraging. That's excellent. Yeah. You know what the one thing I didn't ask you, it's so funny, who named the company and how do you guys say it

Paul Edick 52:30
different people in the company say different ways. Some people say seris, and some say Cirrus, the original name was by the Chief Scientist using a similar rationale to Xerox, which was dry printing is not really dry can still a liquid, but it's without water. So his, he said, you know, serious is for dry drugs like xeriscaping, etc. So that's where he came. That's where he came up with it.

Scott Benner 53:03
I'm never in favor of letting the really smart people do the creative stuff, but I hear what you're saying.

Paul Edick 53:09
You never let a scientist name the company, but it was already done.

Scott Benner 53:13
You know, it's and what's the name of the G, Volk, g Volk,

Paul Edick 53:18
glucagon evoke, it evokes your

Scott Benner 53:21
your glucagon from your liver. Now see, now we had a marketing person involved. I see. There we go. I would ask you more about it. But it's it's fascinating. I don't think people understand either that the FDA has really strict rules on it. But you can even name drugs and drug names go through a lot of so they can't be confused with something else. And like there's a lot that goes on that I think nobody really hears. Paul, I really genuinely appreciate you doing this. Thank you so much for coming on. Thank you. In a few months, we're gonna have someone back on to talk a little more about evoke more of the nuts and bolts about how it works, the science of it and the use. But for now, I just thought it was interesting to hear from Paul and find out how the leadership of a company that brought you the world's first liquid stable glue gun thought and how they got to that thinking. And moreover, I think Paul was just an interesting guest. We don't often get to talk. Those people like this right really break down who they are and where they came from. Ge voke is a prescription medicine used to treat very low blood sugar in kids and adults with diabetes ah two years and above. g voke. is the first ever liquid glucagon it is premix prefilled. Pre measured and ready to use, no refrigeration is needed. g voke has been approved in two formats, a prefilled syringe and an auto injector visit Jeeva glucagon.com forward slash juicebox to learn more

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