Moments of Wonderful

…rather than a lifetime of nothing special. A diabetes blog.

Moments of Wonderful - …rather than a lifetime of nothing special. A diabetes blog.

GlucaPen

Confession – I have never given or received a glucagon injection. In fact, I have never even owned a glucagon kit.

 
I live alone. My reasoning is that if I am low enough to need to use glucagon, I am too low to be able to manage the multiple steps needed to successfully inject it.
 

After the Roche Social Media Summit we were invited by Enject to preview a new product being submitted through the medical approval process that is the next (long awaited) generation of glucagon injections.

GlucaPen
 
The two biggest problems with the current glucagon injections are the fact that they are expecting someone with less experience with needles to use a “big scary one” and the fact that the chemical compounds have to be separated into a powder and a diluent until use.
 
In a high pressure situation, the user needs to draw up liquid, insert it into the vial, throughly mix the solution, and then draw up the solution into the syringe before injecting it into the severely hypoglycemic patient.
 
My mom was in San Diego in time for the presentation and she was the perfect audience since she has never dealt with any injections before and she is a teacher and could potentially have a student in her class who would need her help.
 
inspecting the pen

First, in the GlucaPen, everything is self-contained. There are no multiple pieces to deal to negotiate in an emergency. What you see is what you get.
 
GlucaPen

Second, the user never sees the needle. Notice the yellow cap on top – that is the needle cover and it is impossible to take it off before the glucagon has been mixed and the needle has been primed.
 
safety cap

This next picture shoes the “inside” of the pen. You can see the powder on one side of the plunger and the liquid on the other.
 
pen guts
 

To activate the pen, you first turn the dial at the bottom of the pen (the small white portion visible in these photos – turned from | to 0 ) while holding it vertically.

 
waiting for powder and liquid to mix

As my mom and I each took turns doing that, we could easily see the powder and liquid mixing. There is a clearly audible click when the mixing has completed. At that point you can twist the top off.
 
removing the cap

When you remove the yellow top, there is a small “mist” of fluid as any air in the needle is removed. The flat top is held against the patient (or hypoglycemia orange). The pressure of the pen against the skin is what triggers the needle to deliver the glucagon.
 
mom saving the orange

That is the only potential downside of the system. If the pen loses contact pressure with the skin, the needle retracts and delivery ceases. I would be worried about a patient who is thrashing around not being able to receive the full dose. In normal progression, there is another audible click when the needle retracts at the end of delivery.
 
pointing out the plunger moving fluid

I was the first volunteer to try the system, and with basic instructions (which are printed directly on the pen) I was able to use it very easily. My mom, again with no experience, also was able to “save” the orange with relative ease. (Note: she has her finger on the top in this picture, but that is not what is delivering the glucagon – the pressure of the white portion against the “skin” moves the plunger)
 
I think in an emergency, I could probably even dose myself if I had to, and would actually ask my doctor for a prescription (that is if I did not just find out that my endo has left her practice and I have to find a new one – grr!).
 
There will also be a smaller dose available for children – something that also does not exist in the current delivery system.
 
As Scott Strumello pointed out during the meeting, there has not been a substantial development in the glucagon delivery system since its inception.
 
There are a few steps Enject still needs to take before their product will be on the market – explained towards the bottom of this post.

It is long past time for a product like this to become available to the diabetes community.

GlucaPen
Category: product reviews
  • David Edelman says:

    Sara, great photos and write-up! It’s strange that there’s been so little work in this area. This seems like a big step forward, although still not simple enough. Perhaps each kit should come with a practice one to help familiarize yourself.

    June 30, 2011 at 9:54 am
  • Schmancy says:

    Not that I’ve had to ever use one, but it looks and seems a lot more like an epi pen then the previous method. Thanks for the info Sara. Wonder how much longer we’ll have to wait to see it in Canada?

    June 30, 2011 at 11:51 pm
  • Leah N. says:

    This is so great! Can we start buying them in the US yet? I was just teaching my 7 and 10 year old yesterday how to use the red glucagon shot and both seemed pretty intimidated by the idea….so I told them if mom can’t be woken-up and there are no other adults around…call 911 first, always, and if my kids don’t feel like they can do the glucagon pen then put honey in my mouth and wait for the dr. s to arrive. I don’t think they’ll need to act on this information but it’s good for them to be reminded once in awhile. Another great post Sara!
    p.s. my sister is in Haiti right now for 10 days and it’s made me think of you. :o)

    July 2, 2011 at 3:32 am
    • Sara says:

      I WISH we could buy them in the US! They still have to get through all the approval processes including the FDA. Hopefully soon!

      July 2, 2011 at 3:40 pm
  • Misty says:

    This looks so much less intimidating than the current glucagon. Thank you for sharing! I will be anxiously awaiting FDA approval!

    July 2, 2011 at 7:54 pm
  • Mike Forbes says:

    Too much hype, if you are going to teach your 7 year old I hope they are not the one that needs it. the kit is for people who have passed the point of being able to help themselves, this new one looks easier but the one available in the US is not that difficult. If you are a parent and have given your child injections the us kit is just 1 more step. if your child or adult is hypoglycemic and is still alert, juice will work just fine, if not after you get the us kit you read the instructions and if you are still unsure you either call a 24 hour pharmacy and hope the pharmacist can walk you through it or call the er and hope a nurse or dr can. it should only take 30-60seconds once you have the kit open. The over $100 dollar glucagon kit comes in 2 parts, a syringe filled with sterile water and a vial with glucose powder. You inject the sterile water from the syringe into the vial and swirl it around until clear you then withdraw the water and glucose from the vial and inject it. The thigh is good but any place you would give an insulin shot will suffice. you can practice with an old vial of insulin (empty) and make believe there is powder in it. Take a 1cc or 1/2cc syringe and fill it with water (you can just use tap because you are not going to inject it) you now have a similar set up to the glucagon kit without the glucose and a different looking syringe. inject the water into the vial and swirl it (don’t shake). you can do this a few times or if your insurance company pays for it find out how many they pay for a year and if its 1 a month, you can use the real one to practice with

    July 5, 2011 at 11:20 pm
  • Mike Forbes says:

    sorry I didn’t read the complete post. if it is your child giving you the injection have them practice with the real thing if you don’t have to pay full price or you can afford it. That would be quite intimidating for a 10 year old but with practice they can do it. also have glucose gel and have them put it around your gums, this may be enough to bring you out as it will be absorbed without swallowing. also a mixture of powdered sugar and water will do the same and may be enough to bring you back

    July 5, 2011 at 11:33 pm
  • EllaJane says:

    You can also do a Glucagon rescue, which means mixing it up and putting it in a insulin syringe, I had to do this for my daughter, it’s for when you have a low you can’t get up or for a day when you have the stomach flu, but are obviously still conscious.

    July 6, 2011 at 7:30 am
  • Jim (Beaux) says:

    Sorry but if you can use a pen like this, you can also drink some juice. It seems a little silly to market this to people living alone.

    July 6, 2011 at 10:58 am
    • Daniel says:

      Enject is neither developing nor intending to market the product for self-injection. Nonetheless, many with T1 who have seen a demonstration or seen the video on the company website have made comments similar to the ones made in Sara’s intro.

      July 9, 2011 at 3:30 am
  • kelly close says:

    Jim – sounds like you haven’t seen recently someone way beyond the point where juice will work. there is WAY, way too much severe hypo in the world. juice works a lot of the time but not all the time, and this a product like this is incredibly, incredibly overdue. Sara thanks for the amazing piece, you really do show how simple it is. David, this has probably not been developed because it is not a giant commercial market for it. but, it would be so good if we could all have it as soon as possible.

    July 9, 2011 at 3:51 am
  • Hallie says:

    Thanks, Sara! This is great!
    As someone who recently had to use the glucagon on my five year old child, I think this sounds good! Even if you have practiced, when you are in that moment and your child is seizing and your hands are shaking it is hard to remember the directions and think clearly! I actually bent the needle of the gluc when injecting it into the powder! The current kit is fine – but eliminating steps in process can be helpful! Using the glucagon is a scary thing. Anything that makes it less scary is a plus!

    July 10, 2011 at 8:56 pm
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  • Lora says:

    That looks SO much better than the current system. AND less bulky to carry around. I do agree with the concern of the needle retracting… if the person delivering gets nervous and pulls it out by accident, your screwed. I wish they would reconsider that part, but over all… what a great improvment.

    July 12, 2011 at 3:29 pm
  • etringali says:

    We have been fortunate that we’ve never had to use “Big Red” in an emergency situation. We have used mini doses on a few sick days where juice and glucose tabs weren’t effective. I would much rather have the above pen than big red. We are fortunate that we have friends and family willing to take watch our child, and a less intimidating emergency kit would probably make them all a little less nervous. Will have to keep an eye out for this to get FDA approval. Looks like a great idea!

    July 12, 2011 at 9:12 pm
  • DC Scribe says:

    In 52 years with T1, not one of my battalion of endos has ever said the word “glucagon” much less told me to get it. In fact, I never heard of the stuff until I say a reference several months ago online. I will never have it or any similar product. I found my D sweet spot years ago – never had a seizure, no complications, never a serious problem I could not manage myself. It you need it, or more importantly, think you need it, then get it. But as is the case with so much other stuff from the Diabetes Industrial Complex (DIC) it seems to me there’s a mismatch between the actual need for the stuff and marketing claims.

    July 17, 2011 at 11:16 am
  • Shara says:

    I can’t wait until this is available! I have a 12 year old son with Type 1 and our Park District will administer the epi pen but understandably not the Glucagon. If the GlucaPen is this simple, he may be able to attend day camps safely providing there is proper training.

    March 18, 2012 at 11:48 pm
  • Robyn says:

    I have had Type 2 diabetes since I was 14 years old. I have recently gone on to Insulin in the last few years and have noticed that I have some really low lows and this epi pen like system would be really helpful to me in work environments just in case I where to have a Hypo. I have not yet had a severe enough low for the glucose injection, but we keep one in the house anyway (only ours in Australia is in an orange coloured kit).

    I would love to see this concept become available to the global market and it could be a potential life saver.

    That is all.

    October 15, 2013 at 3:22 pm

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