Low-dose glucagon - for "open-loop" hypoglycemia prevention

When striving for strict metabolic control to reduce late‐onset diabetes complications, episodes of mild hypoglycemia occur frequently in type 1 diabetes (T1D) due to relative insulin overdosing. Strategies aimed at preventing mild hypoglycemia have traditionally been limited to lowering the insulin dose and increasing the consumption of oral carbohydrates. Since obesity is a growing problem in T1D, it has been hypothesized that avoiding the extra caloric intake associated with supplementary carbohydrates to prevent hypoglycemia can help maintain a positive weight balance. In the last few decades, where the development of closed‐loop treatment has taken place, several academic research groups have gathered experience with dual‐hormone (glucagon and insulin) closed‐loop treatment. Systematic reviews have shown superiority of dual‐hormone to single‐hormone closed‐loop systems in lowering the incidence of hypoglycemia. Yet, no dual‐hormone closed‐loop system has been brought to market and used in clinical practice. Until recently, glucagon was only available in powder form, but several companies have now developed soluble glucagon. Soluble glucagon is available not only in vials but also in injection pens. This opens up the possibility for people with T1D to self‐administer low‐dose glucagon as a means to prevent and/or treat mild hypoglycemia, independent of their insulin regime per se. The objective of this talk is to present studies in which the efficacy, safety, and feasibility of injecting low‐dose native or soluble glucagon on different causes of hypoglycemia in T1D have been assessed.