Haven’t you always wondered why Glucagon Emergency Kits are so effing complicated? I mean, in the event of an actual emergency, if some PWD is 
lying unconscious on the floor, tasking a friend or family member to fumble with a delicate vial, gi-normous syringe, and what-looks-easy-but-in-reality is about a 12-step process to get the whole thing going only extends the nightmare for everyone involved!
Enter Enject, the smart folks who are developing a simple-to-use glucagon pen, aptly named the GlucaPen. I’ve written about them before, and they were even an entrant in last year’s DiabetesMine Design Challenge (although their video did not explain the potential impact of this clever product). The company has had challenges of its own getting the product ready for market. I caught up with Enject’s CEO Dick Rylander at the recent ADA Conference and learned some pretty interesting stuff.
First off, there is a much bigger market need for a pen to treat hypoglycemia than for the ubiquitous EpiPen used to treat allergic reactions. Consider this data (click on chart to enlarge):
{see chart data source here}
In addition, there are only about 9,500 hospital admissions per year due to severe allergic reactions, versus more than 350,000 for hypoglycemia, according to data from Kaiser.
The Challenges
Guess why no one’s bothered to put glucagon into a pen delivery system yet (which seems like such an obvious win-win)? Because it is scientifically DIFFICULT; glucagon is not stable in liquid format, meaning it only stays active for a very short time — which is why it needs to be mixed immediately before use. Figuring out how to accomplish this in a pen form factor has been Enject’s biggest challenge.
“We found this company in Germany that is the only place that manufactures these special dual-chamber cartridges we needed to make this product a reality,” Rylander tells me. “It took a while to figure out how to add a little depression inside one of the chambers that can be activated when you press the pen, to allow the powder and liquid to mix, only when needed.”
The second challenge was making it easy to use.
“It’s only a three-step process, but in our early focus groups, people didn’t know what to do with the pen,” Rylander says. “So we’ve taken their input and added images of steps 1-2-3 going up the pen, to make it really clear.”
I got to try activating a dummy pen, and honestly, it was so easy, I thought I had done something wrong.
The Opportunity
According to Rylander’s research, families dealing with severe allergies tend to buy about 2-6 EpiPen units per year. And insurance companies are happy to cover the cost, because there is data illustrating that it avoids the costs of multiple ER visits.
OK, now be honest: when was the last time you bought a new Glucagon Kit? Do you have more than one, like one at home and one at school or the office? Do you take it on vacation with you? (I never have – in part because my husband shudders just looking at that thing).
But if the glucagon were in a nice, simple pen format, and your insurance covered the cost of several new units per year, wouldn’t you be happy to keep them around? Much like the folks with allergies always have their EpiPens at the ready…
This is what Enject is betting on. They’re also forseeing purchases by schools and ambulances/fire departments/Emergency Services Units. Why not? The GlucaPen could avoid a ton of discomfort and cost for so many people.
As they are working on finalizing product packaging, and pushing the GlucaPen through the FDA, they are of course hoping to gain the attention of one of the big pharma companies or other potential partners. Personally, I’m thinking Dex4, the leaders in glucose products.
Regardless of who markets it, I’m looking forward to surprising my hubby real soon with a new, kinder and gentler way to revive me in case I pass out.
We do have several glucagon kits. We keep one in her bag that we carry her supplies and OmniPod PDM around in. Another at home. And one at the school office (though there is no “nurse’s office”).
The issue I have is that when we try to train people, their eyes glaze over. It seems so complex. ESPECIALLY for young kids who only need HALF of the liquid.
Add that to the fact that we’ve never actually used it (knock on wood, I can’t believe I just typed those words, please diabetes gods don’t give us a crazy low) makes it difficult to explain.
I don’t know if in a stressful situation if I, an experienced D-Mom, could remember all the steps, let alone expect someone who is overseeing her at school and doesn’t do the day to day diabetes stuff to remember how to use it.
We NEED glucagon kits that have half the regular dosage for kids. Seriously pharma, I hope you are listening!
A couple of our glucagon kits just expired and I plan to take one to school to use for training as we meet with teachers at the beginning of the year.
I think that for young kids who are in school, there should be glucagon kits (with saline instead of the actual glucagon perhaps) that allow people to learn how to use it properly.
I would LOVE a glucagon pen and I would LOVE there to be an option of getting it with the appropriate dose.
My two cents.
@Leighann – yes! I guess you saw that Enject is offering a “Junior Pen” version as well.
AWESOME! This is why I LOVE your website. This is great information on so many fronts. And just so you know — we do have multiple glucagon kits — one is at school, one in the medicine cabinet, and one in the diabetes kit w/ the glucometer that we ALWAYs have with us. I’m guessing that’s pretty normal for parents. And, ahem, tell your husban to suck it up and PRACTICE. Him feeling confident about using it is a hell of a lot better than the alternatives.
One question… can you give less than the full dose? If not, that could be a problem.
Awesome. Just awesome. The Jr. Pen with easy instructions is the answer to our prayers. Teachers always baulk at the glucagon sets. Maybe this will take away the scare factor. LOVE IT!
I have used the glucogon when my diabetic two yr old was seizing. I’m all for a more simple delivery system. I hope the junior pen can accomodate very small children.
I always have a glucagon pen with me, but I have never had to use it. I do replace it whenever it expires.
However, as far as I know, glucagon is not the method of choice for raising blood sugar among paramedics — they use intravenous glucose. So I don’t think that the demand for glucagon can expand to medical professionals, but it would be great for schools and PWDs.
While I found that table really interesting, I’d love to know when that data was from b/c if its recent, then its taking into account all the people that already have, and are using, epipens. If so, it hardly seems like a fair comparison.
As a mother of a type 1 kid, a nurse, and a sub school nurse…I have been awaiting the day for this product. I have been hearing about it for the past 2 years and am so excited for the administration of this livesaving product to be as easy as 1-2-3. Thank you for this informative post!
That needle shield technology is so cool. You never get to see the needle, which is a big deal given the big needle that the crappy kits we have now. Despite the fact that I am unconscious when my kit gets used, I know my family and inner circle are scared of sticking me, and I want the peace of mind that they won’t hurt themselves with secondary needle sticks. I reckon that this will be really appreciated by paramedics and school nurses, not to mention my football coach!
This video says it all: http://www.youtube.com/watch?v=jdCsERsYPo0&feature=related
@Amanda et al – I have just added a link to the data source for the info in the chart. Thx for asking!
I would love to have this. I gave up on keeping glucagon around years ago as my husband is like Amy’s. It’s not that I’ve ever needed it, but it would be a measure of peace of mind to have it on hand and know my husband could easily administer it.
This a no-brainer as a delivery system. Makes too much sense. Perhaps a carrier protein variation could stabilize liquid glucagon at room temps.
GlucaPen now has a Facebook Group: http://www.facebook.com/group.php?gid=130238453681987&ref=ts
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As the mother of 2 kids (1 w/T1D and 1 w/severe allergies) I have to say that having glucagon in a delivery system like the Epi pen is really exciting.
I’m also excited that the Glucapen will be avail in a Jr. dose. My biggest complaint/concern with the current gluc kit is that a panicky adult may over-dose (forgetting to give only 1/2) or that because everything is glass components that they will get dropped or otherwise break. A durable plastic pen with the exact dose solves all that.
I’m thinking I’m in the minority, though, on another point, because I don’t find the current gluc kits to be either too complicated or too scary, and I have just as many gluc kits readily available as I do Epi pens. I order refills thru out the yr and have at least 5 gluc kits on hand at any given time – 2 stay at school and 2 at home and 1 always in my purse. But I’ve had lots of practice mixing the glucagon and keep expired kits for that purpose.
One extra point I’d like to make – I do hope that the Glucapen will not totally replace the current syringe/vial gluc kits. There are times I really appreciate being able to draw glucagon out of a syringe. My child was dx’d @ 18 mos and is now 5 yrs. We use mini glucagon dosing several times a year – we’ve not had to use it for an emergency situtation. When my child gets a GI bug w/frequent vomiting, being able to give mini rescue doses of glucagon at home has kept him out of the ER. (We mix the glucagon with the given syringe, but then draw up a tiny dose with a typical insulin syringe for injecting sub-Q.) It is also invaluable when he gets a significant low (like in the ’30′s) in the middle of the nite and refuses to take anything by mouth. And I’ve used it to counter unintended/unexpected insulin reactions. Giving 1 unit per year of his life brings him back to target range almost instantly, with no high rebounds and no side effects. The mini dose can keep him in range for about 2 hours. Which buys me time and gives me more options to get alternate sugar in, or re-dose. It opens up options I wouldn’t otherwise have. We’ve worked out a great system with his diabetes doctors, who totally support the mini dosing, and have avoided hospital visits numerous times.
[...] Enject’s GlucaPen: Diabetes’ Answer to the EpiPen (diabetesmine.com) [...]
I’ll take 8, please. Three for home…three for each boy at school…and two for the cars.
How many more years do we have to wait for this simple, convenient tool to help us?
[...] Included with her tweet is a link to a post she had written almost one year ago, which you can read here, describing a new GlucoPen that is in the works that reduces the steps required to reconstitute and [...]
The Gluca-pen is truly revolutionary. Wouldlike to see this company move forward on the type of solution that is more automatic. there are ones today that be can be used with an iphone app and monitors regularly.