Guidelines for using glucagon

It only takes one severe hypoglycemic event
to devastate a patient

That's why The ADA Standards of Care
recommend glucagon for all patients
at risk of moderate or severe hypoglycemia.

American Diabetes
Association

Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia so that it is available should it be needed. Glucagon administration is not limited to health care professionals.¹

Despite ADA recommendations,
glucagon is still highly underutilized

9 out of 10 patients*
experienced BG <54 mg/dL over
the last 12 months.²
*n=400

Even with this high burden, utilization
of glucagon emergency kits is low.
Only one-fifth use GEKs.³

Patients experience a range of hypoglycemia^1,4,5

Normal Range 80-130 mg/dL

Mild hypoglycemia (level 1) <70 mg/dL

Moderate hypoglycemia (level 2) <54 mg/dL

Severe hypoglycemia (level 3)

The ADA recommends glucagon be
used in people unable or unwilling to eat.¹

Gvoke^® should be used when any of the following are true:⁵

Patient has tried correcting hypoglycemia sugar (or drinks that are high in sugar) and has not improved

Patient is unable to safely swallow sugar or sugar-sweetened products to correct hypoglycemia

Patient feels like they might pass out

Patient experiences loss of consciousness or a seizure

Gvoke can be used even before
the patient passes out⁵

Patients can even give themselves Gvoke in certain situations³

Those around patients should be shown how to use Gvoke before an emergency happens.
They may need to administer it if the patient has severe hypoglycemia.

References: 1. American Diabetes Association. Glycemic targets: Standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S73-S84. 2. Data on file. 3. Valentine V, Newswanger B, Prestrelski S, Andre AD, Garibaldi M. Human factors usability and validation studies of a glucagon autoinjector in a simulated severe hypoglycemia rescue situation. Diabetes Technol Ther. 2019;21(9):522-530. 4. National Institute of Diabetes and Digestive and Kidney Diseases. Hypoglycemia. https://www.niddk.nih.gov/-/media/Files/Diabetes/hypoglycemia_508.pdf. Published July 2021. Accessed October 7, 2021. 5. Gvoke [prescribing information]. Chicago, IL: Xeris Pharmaceuticals, Inc; 2021.

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INDICATION AND IMPORTANT SAFETY INFORMATION

GVOKE is indicated for the treatment of severe hypoglycemia in adult and pediatric patients with diabetes ages 2 years and above.

IMPORTANT SAFETY INFORMATION

Contraindications

GVOKE is contraindicated in patients with pheochromocytoma because of the risk of substantial increase in blood pressure, insulinoma because of the risk of hypoglycemia, and known hypersensitivity to glucagon or to any of the excipients in GVOKE. Allergic reactions have been reported with glucagon and include anaphylactic shock with breathing difficulties and hypotension.

Warnings and Precautions

GVOKE is contraindicated in patients with pheochromocytoma because glucagon may stimulate the release of catecholamines from the tumor. If the patient develops a dramatic increase in blood pressure and a previously undiagnosed pheochromocytoma is suspected, 5 to 10 mg of phentolamine mesylate, administered intravenously, has been shown to be effective in lowering blood pressure.

In patients with insulinoma, administration of glucagon may produce an initial increase in blood glucose; however, GVOKE administration may directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia. GVOKE is contraindicated in patients with insulinoma. If a patient develops symptoms of hypoglycemia after a dose of GVOKE, give glucose orally or intravenously.

Allergic reactions have been reported with glucagon. These include generalized rash, and in some cases, anaphylactic shock with breathing difficulties and hypotension. GVOKE is contraindicated in patients with a prior hypersensitivity reaction.

GVOKE is effective in treating hypoglycemia only if sufficient hepatic glycogen is present. Patients in states of starvation, with adrenal insufficiency or chronic hypoglycemia, may not have adequate levels of hepatic glycogen for GVOKE administration to be effective. Patients with these conditions should be treated with glucose.

Necrolytic migratory erythema (NME), a skin rash commonly associated with glucagonomas (glucagon-producing tumors) and characterized by scaly, pruritic erythematous plaques, bullae, and erosions, has been reported postmarketing following continuous glucagon infusion. NME lesions may affect the face, groin, perineum and legs or be more widespread. In the reported cases NME resolved with discontinuation of the glucagon, and treatment with corticosteroids was not effective. Should NME occur, consider whether the benefits of continuous glucagon infusion outweigh the risks.

Adverse Reactions

Most common (≥5%) adverse reactions associated with GVOKE are nausea, vomiting, injection site edema (raised 1 mm or greater), and hypoglycemia.

Drug Interactions

Patients taking beta-blockers may have a transient increase in pulse and blood pressure when given GVOKE. In patients taking indomethacin, GVOKE may lose its ability to raise blood glucose or may even produce hypoglycemia. GVOKE may increase the anticoagulant effect of warfarin.

Guidelines for using glucagon

It only takes one severe hypoglycemic event to devastate a patient

Despite ADA recommendations,glucagon is still highly underutilized

Patients experience a range of hypoglycemia1,4,5

Gvoke® should be used when any of the following are true:5

Gvoke can be used even beforethe patient passes out5

Patients can even give themselves Gvoke in certain situations3

It only takes one severe hypoglycemic event
to devastate a patient

Despite ADA recommendations,
glucagon is still highly underutilized

Patients experience a range of hypoglycemia^1,4,5

Gvoke^® should be used when any of the following are true:⁵

Gvoke can be used even before
the patient passes out⁵

Patients can even give themselves Gvoke in certain situations³