GVOKE – a New Option to Treat Severe Hypoglycemia

Hypoglycemia or low blood sugar is a common and scary side-effect of insulin diabetes management. Hypoglycemia can not only be uncomfortable and scary but also outright life-threatening.

If you take insulin to manage your diabetes, you’ll likely experience hypoglycemia at some point. That’s why it’s very important that you know the symptoms of hypoglycemia, and how to handle it when it happens. (And teach your friends how to handle it, too, in case you need help!).

In this article, I’ll discuss severe hypoglycemia and how it can be treated by using GVOKETM a recently FDA approved glucagon product (approved September 2019).

This post is sponsored by Xeris Pharmaceuticals, Inc. the manufacturer of GVOKE

What is severe hypoglycemia

Hypoglycemia is when your blood sugar levels have fallen low enough that you need to take action to bring them back to your target range. Usually when your blood sugar is less than 70 mg/dL (3.9 mmol/L).

In people with type 1 and type 2 diabetes, low blood sugar is generally caused by an imbalance of food, activity, and insulin — or other diabetes medications that lower blood sugar. Simply getting one more unit of insulin than you may have needed for a meal can lead to hypoglycemia.

The symptoms you feel most when your blood sugar is dropping may be a little different than what someone else feels, and you might feel these symptoms even before your blood sugar drops below 70 mg/dl (3.9 mmol/L). On the other hand, some people have what’s called “hypoglycemia unawareness” which means they don’t feel any symptoms at all.

Severe hypoglycemia is a bit different than the average low blood sugar. Severe hypoglycemia is when your blood sugar is so low that you need help from someone else to treat it and recover.

You can learn more about the symptoms and causes of hypoglycemia HERE.

What is glucagon and how does it work?

In the case of severe hypoglycemia, you should teach your family and friends the dangers of trying to help you by forcing you to eat or drink. This can be dangerous because when your blood sugar is that low, you may not be alert enough to chew or swallow, which means your risk of choking is very high.

That’s where glucagon comes in — along with a phone-call to 911.

Glucagon is a hormone produced in your body, but it can also be taken via injection to treat severe hypoglycemia. Glucagon tells your liver to release glycogen — a form of glucose (sugar) stored in your liver. Then your body converts that glycogen into glucose to raise your blood sugar to a safe level.

According to Jeff Hitchcock, founder and president of Children with Diabetes, many people (particularly parents) are hesitant to use conventional glucagon kits because the complex preparation feels confusing and perhaps overwhelming. It’s important to overcome this fear and learn how to use a glucagon kit because it could save the life of someone suffering from severe hypoglycemia.

Should you get a glucagon kit?

Whether you’ve had to use a glucagon kit before or not, it’s something that I would highly recommend for anyone taking insulin to manage their diabetes.

I’ve lived with diabetes since December 1997 and have never had to use one, but I have always had one. Why? Because when you do actually need a glucagon kit, it could be the only thing that saves your life or prevents you from having a seizure or coma during severe hypoglycemia.

It’s like wearing a seatbelt. I’ve never been in a car accident but if that happens, I want that seatbelt to protect me.

I keep my glucagon kit at home and bring it with me whenever I hike or travel. I bring it along because, let’s face it, it won’t be any good to me if I leave it at home in the drawer.

What is GVOKE

GVOKE is the first glucagon product approved that is administered via a prefilled syringe (GVOKETM PFS) or auto-injector (GVOKE HypoPenTM). Since it’s prefilled that means it’s always ready to use and significantly reduces the steps to prepare and administer glucagon compared to the glucagon options we’ve had before.

GVOKE is approved to treat severe hypoglycemia in adults and kids with diabetes ages 2 years and above.

Since kids will need less glucagon than an adult, GVOKE comes in two pre-measured dosing options – 1 mg for adults ages 12 and older and 0.5 mg option for children under 12 years of age. Kids under 12 who weigh more than 100 lbs should use the 1 mg dose.

What really sets GVOKE apart is that it is the first-ever liquid glucagon. It is premixed, prefilled, premeasured, and ready to use. And no refrigeration is needed, so you don’t have to worry about keeping it cool.

Both GVOKE products are currently FDA approved, but at this time only GVOKE PFS is commercially available (we will provide an update when the HypoPen comes to market).

Since we’re all different, I think this is an important step in order to offer us living with diabetes more options in regard to our diabetes management.

You should always read the complete safety information on any drug, and since GVOKE is a prescription medicine and should only be used in case of severe hypoglycemia please read the complete safety information at the end of this article and refer to your doctor for administration and usage guidance.

How to use GVOKE

You might have used or been trained to use a glucagon kit before but GVOKE is different, so you need to learn the proper way to use GVOKE.

You should, of course, discuss usage with your doctor and look through the instructions when you receive your first GVOKE prescription, but I find that it’s quite simple. Please note that the GVOKE PFS should remain in the foil pouch until use. So, let’s walk through the steps for administering GVOKE.

The GVOKE PFS (prefilled syringe) that is currently available in the US has 2 simple steps:

1) Take cap off.

2) Pinch the skin and insert needle at 90 degrees. Push plunger to inject.

Once the cap is taken off, the needle can be inserted on bare skin into someone’s belly fat, outer thigh or upper arm. That does mean that any clothing should be removed before injecting GVOKE.

It’s as simple as that. And such a simple 2-step injection process really makes me less anxious about someone else being able to give me that injection correctly.

If I’m passed out from severe hypoglycemia and my husband has to administer glucagon, I really want him to feel very comfortable in the process and how to do it correctly.

Close-up of a GVOKE syringe

What to ask your doctor about hypoglycemia

As with other glucagon products, GVOKE is a prescription medicine so you need to discuss it with your doctor and ask for a prescription.

Since injecting GVOKE PFS is only a two-step process you might not need extensive training, but general medical guidance is always recommended.

If your doctor hasn’t heard about GVOKE, you can always send him/her to the GVOKE website. Sometimes we learn about new diabetes medications and products before our medical team. There are a lot of new drugs coming to market all the time so it happens, and in a situation like that, you’ll just have to educate your team.

How to get GVOKE

After you have discussed glucagon with your doctor and learned how and when to use it, you’ll need to pick up your prescription at the pharmacy or online home delivery fulfilled by PillPack, an Amazon Company. (If you’d like it delivered to your home, information is available at GvokeGlucagon.com).

As with most newly approved drugs, it might take a little time before some insurance companies add it to their covered list. If it’s not added your insurance company might deny coverage of GVOKE.

If you’re denied coverage, it’s recommended that you have your doctor or pharmacist reach out to the insurance company to ask for an exception.

Some people can qualify for financial assistance using the GVOKE copay card if you have eligible commercial insurance and may pay as little as $25.

Xeris Pharmaceuticals (the manufacturer of GVOKE) is offering the copay card through the end of 2020. More information on access and savings can be found at GvokeGlucagon.com.



GVOKE is a prescription medicine used to treat very low blood sugar (severe hypoglycemia) in adults and kids with diabetes ages 2 years and above. It is not known if GVOKE is safe and effective in children under 2 years of age.


Do not use GVOKE if:

  • you have a tumor in the gland on top of your kidneys (adrenal gland), called a pheochromocytoma.
  • you have a tumor in your pancreas, called either an insulinoma or a glucagonoma.
  • you are allergic to glucagon or any other inactive ingredient in GVOKE.


High blood pressure. GVOKE can cause high blood pressure in certain people with tumors in their adrenal glands.

Low blood sugar. GVOKE can cause low blood sugar in certain people with tumors in their pancreas.

Serious skin rash. GVOKE can cause a serious skin rash in certain people with a tumor in their pancreas called a glucagonoma.

Serious allergic reaction. Call your doctor or get medical help right away if you have a serious allergic reaction including:

  • rash
  • difficulty breathing
  • low blood pressure


The most common side effects of GVOKE include:

  • nausea
  • vomiting
  • swelling at the injection site
  • headache

These are not all the possible side effects of GVOKE. For more information, ask your doctor. Call your doctor for medical advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.


Before using GVOKE, tell your doctor about all your medical conditions, including if you:

  • have a tumor in your pancreas
  • have not had food or water for a long time (prolonged fasting or starvation) 

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.


  • Read the detailed Instructions For Use that come with GVOKE.
  • Make sure your caregiver knows where you keep your GVOKE and how to use GVOKE correctly before you need their help.
  • Your doctor will tell you how and when to use GVOKE.
  • GVOKE contains only 1 dose of medicine and cannot be reused.
  • After administering GVOKE, the caregiver should call for emergency medical help right away.
  • If the person does not respond after 15 minutes, another dose may be given.
  • Tell your doctor each time you use GVOKE.
  • Store GVOKE at temperatures between 68°F and 77°F. Do not keep it in the refrigerator or let it freeze.
  • Keep GVOKE in the foil pouch until you are ready to use it.

Keep GVOKE and all medicines out of the reach of children.

For more information, call 1-877-937-4737 or go to www.GvokeGlucagon.com.

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