Preference for Subcutaneously Administered Low-Dose Glucagon Versus Orally Administered Glucose for Treatment of Mild Hypoglycemia: A Prospective Survey Study

INTRODUCTION: Intensive insulin treatment for type 1 diabetes is associated with high risk of mild hypoglycemia. Mild hypoglycemia is usually treated orally with glucose, which may contribute to weight gain. Subcutaneous injection of low-dose glucagon may be a new treatment option for some occasions of mild hypoglycemia in individuals aiming for optimal glycemic control without gaining weight. We investigated under which occasions patients were interested to use low-dose glucagon.

METHODS: In a prospective 2-week event-driven survey, participants registered every event of mild hypoglycemia (sensor or blood glucose ≤ 3.9 mmol/l and/or hypoglycemia symptoms). For each hypoglycemia event, participants registered whether they would have preferred to use low-dose glucagon if the treatment had been available.

RESULTS: A total of 51 participants (13 men, mean ± SD age 43.6 ± 12.5 years, HbA1c 7.3 ± 0.7% (57 ± 8 mmol/mol), BMI 24.9 ± 3 kg/m2) were included. Each participant had on average 10 (range 3-23) mild hypoglycemia events during the 2-week survey period. Glucagon was preferred in 58% of the 514 mild hypoglycemia events (p > 0.05). Twelve percent of the participants had no desire to use glucagon for any hypoglycemia event. The preference pattern did not differ between sex, patient treatment modalities, and possible causes for hypoglycemia (all p > 0.05).

CONCLUSION: This study showed that a majority of our participants with type 1 diabetes were interested in using low-dose glucagon for the treatment of mild hypoglycemia.

FUNDING: This work was funded by a research grant from the Copenhagen University Hospital Hvidovre and by the Danish Diabetes Academy supported by the Novo Nordisk Foundation.