Glucagon as a treatment of severe hypoglycemia: safe and efficacious but underutilized

Over the past 2 decades, a number of different studies have demonstrated that tight metabolic control not only reduces the incidence but also delays the development of complications in people with type 1 and type 2 diabetes. Unfortunately, the intensive insulin therapy required to achieve tight glucose control is also associated with a significantly increased risk of developing hypoglycemia. Hypoglycemia can cause physical as well as psychosocial morbidity, has been associated with adverse neurological manifestations, and can sometimes result in death. It can affect daily activities such as driving, working, and studying and can result in inconvenience and embarrassment as well as cause fear for both the person with diabetes and significant others. This fear is often the biggest barrier for optimal glycemic control. With self-management education and regular monitoring of blood glucose, people with diabetes can learn to recognize their unique signs and symptoms of hypoglycemia, and with improved understanding of how insulin, food, and activity affect blood glucose levels, the patient can learn to prevent hypoglycemia. However, because managing blood glucose can be such a delicate balancing act, it is important to be prepared. An important weapon in the treatment of severe hypoglycemia is the use of glucagon, a treatment that is generally underappreciated, underevaluated, undertaught, and most certainly underutilized. The purpose of this article is to review the role of glucagon in the treatment of severe hypoglycemia and discuss how better information about and understanding of the use of glucagon might be helpful toward alleviating some of the fears surrounding hypoglycemia.