Treatment and prevention of severe hypoglycaemia in people with diabetes: Current and new formulations of glucagon

Abstract

Some therapies for diabetes increase the risk of hypoglycaemia, in particular all insulins and insulin secretagogues, including the glinides and sulfonylureas. Hypoglycaemia remains a major limiting factor to successful glycaemic management, despite the availability of prevention options such as insulin analogues, continuous glucose monitoring, insulin pumps, and dogs that have been trained to detect hypoglycaemia. Non‐severe (self‐treated) and severe (requiring assistance for recovery) hypoglycaemia rates are higher in people with type 1 diabetes, but those with insulin‐treated type 2 diabetes are also at risk. Education and regular review are essential between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention and treatment. Awareness of the potential dangers of hypoglycaemia is fundamental to the optimal management of diabetes. When therapy is intensified to achieve glycaemic targets, it is important that people at risk of severe hypoglycaemia, and particularly their caregivers, have ready access to effective treatment for hypoglycaemia emergencies. The current and potential formulations of glucagon available for treatment of severe hypoglycaemia are reviewed.

The influence of hypoglycemia on the specific quality of life in type 2 diabetes mellitus: a comparative cross-sectional study of diabetics with and without hypoglycemia in Xi’an, China

“…Elliott L [32] reported that the incidence rates of severe hypoglycemia in T2DM patients the incidence rates ranged from 0 to 20 per 100 person-years. Non-severe hypoglycemia events usually generate autonomic and neuroglycopenic symptoms which enable the individual to identify the onset, and to treat the falling blood glucose without requiring assistance while severe hypoglycemia is associated with impaired cognitive and physical functioning and the progressive neuroglycopenia interferes with the ability to self-treat [33]. Hypoglycemia and fear of hypoglycemia may further reduce adherence to glucoselowering regimens, contributing to the further aggravation of diabetes-related complications.…”

The Influence of Hypoglycemia on the Specific Quality of Life in Type 2 Diabetes Mellitus: a Comparative Cross-sectional Study of Diabetics With and Without Hypoglycemia in Xi'an, China

“…There is no doubt that hypoglycemia puts patients at risk for falls, fall-related injuries [30], dementia and death. Non-severe hypoglycemia events usually generate autonomic and neuroglycopenic symptoms which enable the individual to identify the onset, and to treat the falling blood glucose without requiring assistance while severe hypoglycemia is associated with impaired cognitive and physical functioning and the progressive neuroglycopenia interferes with the ability to self-treat [31]. Hypoglycemia and fear of hypoglycemia may further reduce adherence to glucose-lowering regimens, contributing to the further aggravation of diabetes-related complications.…”

Out-of-Hospital Management of Diabetic Emergencies in Germany: Structural and Process Quality

“…Glucagon administered i.m. has a slower onset and peak activity, resulting in slower restoration of normal consciousness than i. v. dextrose [14,15], but carries fewer risks of necrotising vascular and extravascular complications.…”