Recently the FDA approved Baqsimi, a nasal gulcagon spray.
With a single easy to administer nasal spray persons with diabetes can be rescued from a critically low blood sugar. This is an amazing improvement in our safety. Until now glucagon, a hormone that triggers the liver to release stores glucose, could only be administered with a large and imposing intramuscular injection. The medication also had to be mixed in a vial, a complicated and intimidating process for someone who has not been trained. This life saving measure is often not performed or is greatly delayed, particularly for people living, working, or traveling on their own away from close friends and family members. Now, with Baqsimi we have an easy to administer option that will greatly increase the likelihood that a stranger who just happens to be on the scene during a diabetic emergency will be able and willing to give life saving assistance.
However, there are two things to know when using Baqsimi for emergency treatment of hypoglycemia.
- The first is that there is nothing about the packaging of Baqsimi that would let someone know that it is for an emergency at a glance. The unassuming grey white and yellow packaging does not exactly cry out for emergency response. There are tiny illustrated directions on how to administer Baqsimi on the outer container, but I would recommend that users put something on the bottle that indicates its use for emergencies. A red Medical Alert symbol sticker would be helpful.
- The second thing to know when starting on Baqsimi is to not abandon your injected glucagon. One thing that injected glucagon can do that nasal spray can’t is be micro dosed. Micro dosing can be a vital tool in dealing with sick day management. We wouldn’t want to lose the ability to treat illness (potentially having that turn into an emergency) as a trade off for treating an emergency! An important piece of diabetes management is having the right tools! But now we run into the issue of insurance companies not wanting to cover two medications for the same thing. I found success in having my prescriber write an order for injected glucagon for “As needed use of prevention of DKA per sick day protocol” and the order for the Baqsimi for “As needed use for treatment of critical hypoglycemia” This, accompanied by a prior authorization allowed for both medications to be covered since they are similar in effect but different in action to treat different issues.
We are also still keeping an eye out for expected FDA approval of Xeris medical’s shelf stable glucagon auto injector. This will offer another glucagon administration option with easy administration. (not to mention competition, and healthy competition helps drive the pricing market as well as further innovation)
The Final Word
Remember, glucagon at the pharmacy can help you! Anyone on insulin or insulin production stimulating medications should have a glucagon rescue kit on hand and people in their life should know about it and how to use it, in whatever form that takes.
Be sure to look for expiration dates, as glucagon doesn’t last long!