Mini-Dose Glucagon for Mild and Moderate Hypoglycemia in Type 1 Diabetes
Main Article Content
Abstract
Tight glycemic control reduces the development and progression of microvascular and macrovascular complications in individuals with type 1 diabetes. However, it is also associated with an increased risk of hypoglycemia, which can deter some individuals from striving to achieve tight glycemic control. For this and other reasons, it is important to optimize the treatment of hypoglycemia in type 1 diabetes. The conventional approach to the management of mild to moderate hypoglycemia is oral carbohydrate ingestion, which can result in significant rebound hyperglycemia and the consumption of excess calories with resulting unwanted weight gain. Studies of the use of subcutaneous mini-dose glucagon for the prevention and treatment of mild to moderate hypoglycemia in a variety of settings have demonstrated that this approach is safe and effective and is less likely to result in significant hyperglycemia and the ingestion of unwanted oral carbohydrate calories.
Article Details
How to Cite
FARKAS, Hal Steven; LESCHEK, Ellen Werber.
Mini-Dose Glucagon for Mild and Moderate Hypoglycemia in Type 1 Diabetes.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5866>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5866.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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8. Haymond MW, Schreiner B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes Care. 2001;24(4):643-645.
9. Hartley M, Thomsett MJ, Cotterill AM. Mini-dose glucagon rescue for mild hypoglycaemia in children with type 1 diabetes: the Brisbane experience. J Paediatr Child Health. 2006;42(3):108-111.
10. Busselo TMJ, Domingo JA, Marra EM. Mini-dose of glucagon: great efficacy avoiding admission of insulin-dependent-diabetic children with decreasing nomoglycemie or hypoglycemie due to vomiting or gastroenteritis. Nature.com. Accessed August 18, 2024. pr2010925.pdf (nature.com)
11. Chung ST, Haymond MW. Minimizing morbidity of hypoglycemia in diabetes: a review of mini-dose glucagon. J Diabetes Sci Technol. 2015;9(1):44-51.
12. Tinti D, Rabbone I. Mini-doses of glucagon to prevent hypoglycemia in children with type 1 diabetes refusing food: a case series. Acta Diabetol. 2020;57(3):359-365.
13. Rickels MR, DuBose SN, Toschi E, Beck RW, Verdejo AS, Wolpert H et al. Mini-dose glucagon as a novel approach to prevent exercise-induced hypoglycemia in type 1 diabetes. Diabetes Care. 2018;41(9):1909- 1916.
14. Steineck IIK, Ranjan A, Schmidt S, Clausen TR, Holst JJ, Norgaard K. Preserved glucose response to low-dose glucagon after exercise in insulin-pump-treated individuals with type 1 diabetes: a randomized crossover study. Diabetologia. 2019;62(4):582-592.
15. Aronson R, Riddell MC, Conoscenti V, Junaidi MK. Effect of mini-dose ready-to-use liquid glucagon on preventing exercise-associated hypoglycemia in adults with type 1 diabetes. Diabetes Care. 2023;46(4):765-772.
16. Algeffari Metab, Hussain S, Almogbel T, Alsharidah M, Alghadouni H, Mahmood F. Home use of mini-dose glucagon as a novel treatment for hypoglycemia following repeated, prolonged fasts in type 1 diabetes during Ramadan. Diabetes Care. 2022;45(4):990-993.
17. Hasan KS, Kabbani M. Mini-dose glucagon is effective at diabetes camp. J Pediatr. 2004;144(6):834.
18. Ranjan A, NØrgaard K, Tetzchner R, Steineck IIK, Clausen TR, Holst JJ et al. Effects of preceding ethanol intake on glucose response to low-dose glucagon in individuals with type 1 diabetes: a randomized, placebo-controlled, crossover study. Diabetes Care. 2018;41(4):797-806.
19. Haymond MW, DuBose SN, Rickels MR, Wolpert H, Shah VN, Sherr JL et al. Efficacy and safety of mini- dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes. J Clin Endocrinol Metab. 2017;102(8):2994-3001.
20. Pieber TR, Aronson R, Hövelmann U, Willard J, Plum- Mörschel L, Knudsen et al. Dasiglucagon – a next- generation glucagon analog for rapid and effective treatment of severe hypoglycemia: results of a phase 3 randomized double-blind clinical trial. Diabetes Care. 2021;44(6):1361-1367.
21. Laugesen C, Ranjan AG, Schmidt S, Norgaard K. Low- dose dasiglucagon versus oral glucose for prevention of insulin-induced hypoglycemia in people with type 1 diabetes: a phase 2, randomized, three-arm crossover study. Diabetes Care. 2022;45(6):1391- 1399.
22. Tetzchner R, Ranjan AG, Schmidt S, NØrgaard K. Preference for subcutaneously administered low-dose glucagon versus orally administered glucose for treatment of mild hypoglycemia: a prospective survey study. Diabetes Ther. 2019;10(6):2107-2113.
23. Hughes AS, Chapman K, Bispham J, Dimsits J, Weinzimer S, Wolf W et al. “It’s embarrassing. I get angry. I get frustrated.”: Understanding severe hypoglycemia and glucagon usage from the perspectives of people with type 1 diabetes. J Clin Transl Endocrinol. 2022 Oct 19;30:100310.
24. Brink S, Laffel L, Likitmaskul S, Liu L, Maguire AM, Olsen B et al. ISPAD clinical practice consensus guidelines 2009 compendium: sick day management in children and adolescents with diabetes. Pediatr Diabetes. 2009Sep;10 Suppl12:146-153.
25. Mini dose glucagon: Pediatric Endocrine Society. October 4, 2021. Accessed August 20, 2024. https://pedsendo.org/patient-resource/mini-dose- glucagon.
26. Mini dose glucagon rescue: Children with Diabetes. October 20, 2020. Accessed August 20, 2024. https://childrenwithdiabetes.com/blood-sugar- management-t1d/mini-dose-glucagon-diabetes/
2. Gubitosi-Klug RA, Braffett BH, White NH, Sherwin RS, Service FJ, Lachin JM et al. Risk of severe hypoglycemia in type 1 diabetes over 30 years of follow-up in the DCCT/EDIC study. Diabetes Care. 2017;40(8):1010-1016.
3. Sherman JJ, Lariccia JL. Glucagon therapy: a comparison of current and novel treatments. Diabetes Spectr. 2020;33(4):347-351.
4. Templer S. Closed-loop insulin delivery systems: past, present, and future directions. Front Endocrinol. June 6, 2022. Accessed August 18, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC920 7329/.
5. Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez AM, Mbogo J et al. ISPAD clinical practice consensus guidelines 2022: assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1322-1340.
6. Haymond MW, Redondo MJ, McKay S, Cummins MJ, Newswanger B, Kinzell J. Nonaqueous, mini-dose glucagon for treatment of mild hypoglycemia in adults with type 1 diabetes: a dose-seeking study. Diabetes Care. 2016;39(3):465-468.
7. Bumbu A, Moutairou A, Matar O, Fumeron F, Velho G, Riveline J-P et al. Non-severe hypoglycaemia is associated with weight gain in patients with type 1 diabetes: results from the diabetes control and complication trial. Diabetes Obes Metab. 2018;20(5):1289-1292.
8. Haymond MW, Schreiner B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes Care. 2001;24(4):643-645.
9. Hartley M, Thomsett MJ, Cotterill AM. Mini-dose glucagon rescue for mild hypoglycaemia in children with type 1 diabetes: the Brisbane experience. J Paediatr Child Health. 2006;42(3):108-111.
10. Busselo TMJ, Domingo JA, Marra EM. Mini-dose of glucagon: great efficacy avoiding admission of insulin-dependent-diabetic children with decreasing nomoglycemie or hypoglycemie due to vomiting or gastroenteritis. Nature.com. Accessed August 18, 2024. pr2010925.pdf (nature.com)
11. Chung ST, Haymond MW. Minimizing morbidity of hypoglycemia in diabetes: a review of mini-dose glucagon. J Diabetes Sci Technol. 2015;9(1):44-51.
12. Tinti D, Rabbone I. Mini-doses of glucagon to prevent hypoglycemia in children with type 1 diabetes refusing food: a case series. Acta Diabetol. 2020;57(3):359-365.
13. Rickels MR, DuBose SN, Toschi E, Beck RW, Verdejo AS, Wolpert H et al. Mini-dose glucagon as a novel approach to prevent exercise-induced hypoglycemia in type 1 diabetes. Diabetes Care. 2018;41(9):1909- 1916.
14. Steineck IIK, Ranjan A, Schmidt S, Clausen TR, Holst JJ, Norgaard K. Preserved glucose response to low-dose glucagon after exercise in insulin-pump-treated individuals with type 1 diabetes: a randomized crossover study. Diabetologia. 2019;62(4):582-592.
15. Aronson R, Riddell MC, Conoscenti V, Junaidi MK. Effect of mini-dose ready-to-use liquid glucagon on preventing exercise-associated hypoglycemia in adults with type 1 diabetes. Diabetes Care. 2023;46(4):765-772.
16. Algeffari Metab, Hussain S, Almogbel T, Alsharidah M, Alghadouni H, Mahmood F. Home use of mini-dose glucagon as a novel treatment for hypoglycemia following repeated, prolonged fasts in type 1 diabetes during Ramadan. Diabetes Care. 2022;45(4):990-993.
17. Hasan KS, Kabbani M. Mini-dose glucagon is effective at diabetes camp. J Pediatr. 2004;144(6):834.
18. Ranjan A, NØrgaard K, Tetzchner R, Steineck IIK, Clausen TR, Holst JJ et al. Effects of preceding ethanol intake on glucose response to low-dose glucagon in individuals with type 1 diabetes: a randomized, placebo-controlled, crossover study. Diabetes Care. 2018;41(4):797-806.
19. Haymond MW, DuBose SN, Rickels MR, Wolpert H, Shah VN, Sherr JL et al. Efficacy and safety of mini- dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes. J Clin Endocrinol Metab. 2017;102(8):2994-3001.
20. Pieber TR, Aronson R, Hövelmann U, Willard J, Plum- Mörschel L, Knudsen et al. Dasiglucagon – a next- generation glucagon analog for rapid and effective treatment of severe hypoglycemia: results of a phase 3 randomized double-blind clinical trial. Diabetes Care. 2021;44(6):1361-1367.
21. Laugesen C, Ranjan AG, Schmidt S, Norgaard K. Low- dose dasiglucagon versus oral glucose for prevention of insulin-induced hypoglycemia in people with type 1 diabetes: a phase 2, randomized, three-arm crossover study. Diabetes Care. 2022;45(6):1391- 1399.
22. Tetzchner R, Ranjan AG, Schmidt S, NØrgaard K. Preference for subcutaneously administered low-dose glucagon versus orally administered glucose for treatment of mild hypoglycemia: a prospective survey study. Diabetes Ther. 2019;10(6):2107-2113.
23. Hughes AS, Chapman K, Bispham J, Dimsits J, Weinzimer S, Wolf W et al. “It’s embarrassing. I get angry. I get frustrated.”: Understanding severe hypoglycemia and glucagon usage from the perspectives of people with type 1 diabetes. J Clin Transl Endocrinol. 2022 Oct 19;30:100310.
24. Brink S, Laffel L, Likitmaskul S, Liu L, Maguire AM, Olsen B et al. ISPAD clinical practice consensus guidelines 2009 compendium: sick day management in children and adolescents with diabetes. Pediatr Diabetes. 2009Sep;10 Suppl12:146-153.
25. Mini dose glucagon: Pediatric Endocrine Society. October 4, 2021. Accessed August 20, 2024. https://pedsendo.org/patient-resource/mini-dose- glucagon.
26. Mini dose glucagon rescue: Children with Diabetes. October 20, 2020. Accessed August 20, 2024. https://childrenwithdiabetes.com/blood-sugar- management-t1d/mini-dose-glucagon-diabetes/