For Healthcare Providers

Severe Hypoglycemia Information

Diabetes Canada guidelines for hypoglycemia

For individuals with diabetes who are at increased risk for severe hypoglycemia, Diabetes Canada recommends that support persons be taught how to administer glucagon should it be needed.1

Mild

Autonomic symptoms are present. The individual is able to self-treat.

Moderate

Autonomic and neuroglycopenic symptoms are present. The individual is able to self-treat.

Severe

Typically <2.8 mmol/L

Individual requires assistance of another person. Unconsciousness may occur.

Major risk factors for severe hypoglycemia

For patients with Type 1 diabetes: 1
  • Prior episode of severe hypoglycemia
  • Current low A1C (<6.0%)
  • Hypoglycemia unawareness
  • Long duration of insulin therapy
  • Autonomic neuropathy
  • Children unable to detect and/or treat mild hypoglycemia on their own
  • Adolescence
For patients with Type 2 diabetes: 1
  • Advancing age
  • Severe cognitive impairment
  • Poor health literacy
  • Food insecurity
  • Increased A1C
  • Hypoglycemia unawareness

Events are more common in those with a history of hypoglycemia and those with longer duration of insulin treatment1

For the full Diabetes Canada guidelines please click here

Data on the prevalence of severe hypoglycemia in Canada

Visit the links below to download studies in the prevalence of severe hypoglycemia in Canadians with Type 1 and Type 2 diabetes on insulin therapy.2,3

Download Aronson et al.
Download Leiter et al.

References:

  1. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2018;42 (Suppl 1):S1-S325.
  2. Leiter LA, Yale J-F, Chiasson J-L, et al. Assessment of the impact of fear of hypoglycemic episodes on glycemic and hypoglycemia management. Can J Diabetes 2005;29(3):00-00.
  3. Aronson R, Goldenberg R, Boras D, et al. The Canadian hypoglycemia assessment tool program: insights into rates and implications of hypoglycemia from an observational study. Can J Diabetes 2018;42(2)11-17.
  4. Data on file. Amphastar Pharmaceuticals, Inc.

Indications and Important Safety Information

Clinical use:
BAQSIMI has not been studied in pediatric patients less than 4 years old.

Limited clinical trial experience has not identified difference in responses between elderly (≥65 years of age) and younger patients.

Contraindications:

  • Hypersensitivity to glucagon or to any ingredient in the formulation or container
  • Pheochromocytoma
  • Insulinoma

 

Most serious warnings and precautions:
Lack of response: BAQSIMI should be given only in patients where impaired consciousness precludes oral carbohydrates. After intranasal administration of BAQSIMI, the patient will normally respond within 15 minutes. If the patient does not respond within 15 minutes, intravenous glucose must be administered as soon as IV access can be established.

States of starvation, adrenal insufficiency or chronic hypoglycemia: Because glucagon is of little or no help in these cases, intravenous glucose should be used for the treatment of hypoglycemia in these conditions.

Other relevant warnings and precautions:

  • Cardiovascular effects
  • Driving and operating machinery
  • Pheochromocytoma
  • Insulinoma
  • Sensitivity and resistance to glucagon
  • Pregnant women
  • Breast-feeding
  • Pediatrics (<4 years of age)
  • Geriatrics (≥65 years of age)
  • Use in patients with Type 2 diabetes taking sulfonylureas
  • Use with alcohol
  • Monitoring and laboratory tests

 

For more information:
Consult the Product Monograph at https://pdf.hres.ca/dpd_pm/00074561.PDF for additional important information relating to warnings and precautions, adverse reactions, drug interactions and dosing information which have not been discussed in this piece. The Product Monograph is also available by calling 1-800-423-4136.

Indications and Important Safety Information

Clinical use:
BAQSIMI has not been studied in pediatric patients less than 4 years old.

Limited clinical trial experience has not identified difference in responses between elderly (≥65 years of age) and younger patients.

Contraindications:

  • Hypersensitivity to glucagon or to any ingredient in the formulation or container
  • Pheochromocytoma
  • Insulinoma

 

Most serious warnings and precautions:
Lack of response: BAQSIMI should be given only in patients where impaired consciousness precludes oral carbohydrates. After intranasal administration of BAQSIMI, the patient will normally respond within 15 minutes. If the patient does not respond within 15 minutes, intravenous glucose must be administered as soon as IV access can be established.

States of starvation, adrenal insufficiency or chronic hypoglycemia: Because glucagon is of little or no help in these cases, intravenous glucose should be used for the treatment of hypoglycemia in these conditions.

Other relevant warnings and precautions:

  • Cardiovascular effects
  • Driving and operating machinery
  • Pheochromocytoma
  • Insulinoma
  • Sensitivity and resistance to glucagon
  • Pregnant women
  • Breast-feeding
  • Pediatrics (<4 years of age)
  • Geriatrics (≥65 years of age)
  • Use in patients with Type 2 diabetes taking sulfonylureas
  • Use with alcohol
  • Monitoring and laboratory tests

 

For more information:
Consult the Product Monograph at https://pdf.hres.ca/dpd_pm/00074561.PDF for additional important information relating to warnings and precautions, adverse reactions, drug interactions and dosing information which have not been discussed in this piece. The Product Monograph is also available by calling 1-800-423-4136.