Severe Hypoglycemia Treatment has Changed. Help People with Diabetes have a Safer Rescue

Debbie Hinnen APN, CDCES, BC-ADM, FAAN, FADCES

Hypoglycemia definitions have been updated in the past few years. 

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), based on the international hypoglycemia study group have advised: 

  1. Level 1: Glucose Alert is still a glucose of 70mg.  Beta-adrenergic symptoms are noticeable by PWD and those around them:  shaky, sweaty, hungry, crabby.  And treatment is oral carbohydrates 

    a. The Rule of 15 is a long-standing guideline: 15 grams of carbohydrate, wait 15 minutes and recheck glucose level.  Then follow with a snack with complex carbohydrate/solid protein. 

  1. Level 2 is defined as a glucose level of 54mg 1,2 

    a. At this level PWD begin to have cognitive impairment. People can’t think well.  Remember, the brain functions on glucose only. 

    b. Oral carbohydrates may not be able to be used.  ADA recommends PWD at risk of glucose 54mg have glucagon prescribed and available. 

  1.  Level 3, is still called severe hypoglycemia.  There is no specific glucose level identified. 

    a. The PWD has cognitive/mental and/or physical impairment.  Assistance is needed to treat.  It is not safe to try to use oral carbohydrates. 

    b. Glucagon is the treatment for family, friends and caregivers to use.  The glucagon treatment is now easier to administer and works at essentially the same rate as the glucagon for injection that has to be reconstituted.  After treatment, call 911. 

    i. Glucagon treatments now available as 

    1. BAQSIMI: Lilly. 3mg Nasal spray.  Passively absorbed, even if someone has a cold. 4 
      a. Single dose, no needle, or reconstitution.  Approved for >4 years old. 
      b. Can be carried in heat or cold, but not stored >86 degrees.
    2. G-Voke Hypo Pen: Xeris pharmaceuticals 27g needle (not visible) (Similar to epi pen administration)3 
      a. 0.5 for <6 and <100 lb 
      b. 1.0 for >6 and >100 lb 
      c. Approved for >2 years old 
    3. G-Voke Pre-filled syringe.  Xeris 
  2. Zegalogue (dasiglucagon) Zealand, 2021. 5 
    a. 6 years and older for severe hypoglycemia 
    b. Auto injector and pre-filled syringe with 0.6mg single SC dosing 
    c. Storage 3 years if refrigerated, I year at 77degrees F is not refrigerated5 

The companies have co-pay cards for reducing out of pocket for PWD with commercial insurance. 

Patient education around hypoglycemia is important for PWD and their care givers.  It should include hypoglycemia symptoms and treatment.  Patients should identify what they can carry with them AT ALL times for treatments.  Assessment at every clinic visit is necessary to identify problems and change therapy when needed.  Hypoglycemia is scary, the treatment shouldn’t be….

See Debbie Hinnen speak at a 2022 Skin, Bones, Hearts & Private Parts CME Conference. Click here to find out where you can see her live and in-person!

References/Resources 

  1.  International Hypoglycemia Study Group 2017. www.Ihsgonline.com
  1. ADA. Diabetes Care. 2019;41(suppl 1):S1-S193 
  1.  https://www.gvokeglucagon.com/savings-and-support  
  1. BAQSIMI.com  Lilly Diabetes Solution Center: Helpline to assist with paying for insulin and Baqsimi. 833-808-1234 
  1. https://www.zegalogue.com/hcp/glucagon-analog/