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Diabetes - the Medical Perspective
Food and Drug Administration Approves New Treatments for Moderate to Severe Hypoglycemia
Hypoglycemia or low blood glucose occurs when blood glucose drops below 70 mg/dl. Glucagon is a hormone that raises blood glucose by stimulating the liver to release glucose into the blood stream.
A glucagon prescription is recommended for individuals at risk for level 2 hypoglycemia, which is a blood glucose below 54 mg/dl. Moderate and severe hypoglycemia usually occurs in people who take insulin, but it can also happen with some other glucose lowering medications. It is important for family and close contacts of people at risk for significant hypoglycemia to learn how to administer glucagon.
Moderate to severe hypoglycemia can cause confusion and loss of consciousness. In these situations, the person with hypoglycemia requires assistance from someone else.
In July 2019, the Food and Drug Administration (FDA) approved Baqsimi nasal powder, the first non-injectable emergency treatment for severe hypoglycemia. Baqsimi is approved to treat severe hypoglycemia in individuals four years of age and older. Previous glucagon injections required a mixing process. Time is critical when treating hypoglycemia. This new single use method of glucagon administration will simplify the process.
The FDA has also approved GVOKE. GVOKE is a new pre-mixed, liquid glucagon in a prefilled syringe. It is expected to be launched in the U.S. in October 2019. An auto injector GVOKE (similar to an Epi-pen) is expected in 2020. GVOKE is approved for individuals two years of age or older.
These two new glucagon prescription products may not be appropriate for everyone. Your healthcare provider can determine the best method of treating hypoglycemia.
Diabetes and Food
Hypoglycemia is most common in people who have diabetes. It can occur when someone takes too much of a diabetes medication, especially insulin. Skipping meals or cutting back too much on carbohydrate is another cause of hypoglycemia, even with the correct medication dose.
Exercise and physical activity also lowers blood glucose. Carbohydrate intake raise blood sugar.
Diabetes management is a careful balance of food intake, physical activity and medication, if appropriate.
Eating regularly scheduled meals and taking medication as prescribed help prevent hypoglycemia.
Hypoglycemia Treatment Review
Fast acting carbohydrates are used to treat hypoglycemia. The amount of carbohydrate needed to bring blood glucose back up to normal depends on how low it is. The lower the blood glucose, the more fast-acting carbohydrate is needed to bring it back up to a normal level.
It is not safe to place food or liquids in someone’s mouth when they are not alert. A glucagon injection or one of the new FDA approved glucagon administration methods is necessary to treat significant hypoglycemia in these situations.
Remember the 15/15 rule to treat hypoglycemia. This rule is used to treat hypoglycemia when the person is still alert and able to safely consume a fast-acting carbohydrate.
If blood glucose is below 70 mg/dl eat or drink 15 grams of fast-acting carbohydrate. It may take 30 grams of fast-acting carbohydrate, depending on how low your glucose is.
Wait 15 minutes and recheck blood glucose. It takes about 15 minutes to feel better despite the amount of carbohydrate consumed. If blood glucose is still low, treat with an additional 15 grams of fast-acting carbohydrate. If no meal or snack is planned follow-up with a glucose check one hour after treatment.
Seek medical advice if unable to effectively treat and maintain a safe blood glucose level.
Sources of fast-acting carbohydrates:
- 4 ounces of juice
- 4 ounces of regular soda
- 5-6 Lifesavers
- 3-4 Glucose tablets
- 15 gram tube of glucose gel or liquid
Do not hesitate to ask for a referral to a certified diabetes educator and/or registered dietitian for diabetes self-management education. It is wise to review your diabetes meal plan and medication schedule on a regular basis.