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.
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.
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.
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.
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.
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.
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.
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.
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.
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.