Guidelines for using glucagon

The American Diabetes Association recommendation for prescribing glucagon1

Glucagon should be prescribed for all individuals at increased risk of level 2 hypoglycemia, defined as blood glucose <54 mg/dL (3.0 mmol/L), so it is available should it be needed.

Patients may be at risk of hypoglycemia for a variety of reasons1-4

Management-related factors
  • Aggressive glycemic control
  • Inadequate glycemic control/adherence
  • Glycemic variability
  • Pump or injection errors
  • History of stacking insulin doses
  • Bolusing without testing

Lifestyle or individual factors
  • High-intensity physical activity
  • Skipped or irregular meals
  • Erratic schedule
  • Stress
  • Alcohol use
  • Poor cognitive status or psychological disorders
  • Increased insulin sensitivity
  • History of severe hypoglycemia
  • Hypoglycemia unawareness
  • Duration of diabetes
  • Comorbidities

Gvoke should be used when any of the following are true:5
  • Patient has tried to consume sugar or drinks that are high in sugar and has not improved
  • Patient is unable to eat sugar or sugar-sweetened products
  • Patient is having a seizure
  • Patient is unconscious

References: 1. American Diabetes Association. Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S61-S70. 2. National Institute of Diabetes and Digestive and Kidney Diseases. Hypoglycemia. Published August 2016. Accessed May 28, 2019. 3. Kedia N. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes Metab Syndr Obes. 2011;4:337-346. 4. Geller AI, Shehab N, Lovegrove MC, et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med. 2014;174(5):678-686. 5. Gvoke Pre-Filled Syringe [instructions for use]. Chicago, IL: Xeris Pharmaceuticals, Inc.