Sugar Pyramid

Glucagon is the hormone that helps to raise blood glucose levels if they go too low but one reason why they’re not a feature of insulin pumps, to date, is that liquid glucagon lacks the stability of insulin.

The lack of stability in liquid form has meant that glucagon injection kits, for treating very low blood sugar, have needed to contain powder which is mixed with solution just prior to the injection being given. This has also meant that glucagon has not been stable enough to be a feature of insulin pumps.

Treating low blood sugar on insulin pumps

Currently, the most advanced way of automatically treating low blood sugar, that is available to the public, has been in the form of Medtronic’s newest insulin pumps which suspend the supply of insulin when a continuous glucose monitoring sensor detects sugar levels are too low.

The technology is a strong way to prevent severe hypos from developing but, as it doesn’t actively work to raise blood glucose levels, it means that blood glucose levels may still remain low until the wearer of the insulin pump takes carbohydrate.

Pumps that deliver glucagon would be able to automatically address low blood sugar levels as soon as they happen. As not only could insulin delivery be suspended but glucagon would be released which would stimulate the liver to release glucose into the blood and therefore switfly raise blood sugar back to safe levels.

New liquid glucagon performs strongly

As new insulin pumps are currently in development that would use both insulin and glucagon (called dual hormone insulin pumps), the type 1 diabetes charity the JDRF have been working with a company called Xeris to develop a stable liquid form of glucagon that can be used in these pumps.

Results have just been published which show the effects of Xeris’ liquid glucagon to be very close in terms of its effectiveness as the powdered glucagon (Novo Nordisk’s GlucaGen) that is used in the currently available glucagon injection kits.

The results are very encouraging and will remove one of the barriers that existed within the development of dual hormone insulin pumps. Whilst artificial pancreas systems are not yet available, it is a strongly positive sign that new features, to enhance the effectiveness of artificial pancreas technology, are already being developed.