Home Use of Mini-Dose Glucagon As a Novel Treatment for Hypoglycemia Following Repeated, Prolonged Fasts in Type 1 Diabetes During Ramadan

OBJECTIVE: We determined the efficacy of self-administered subcutaneous mini-dose glucagon (MDG) to treat fasting-induced hypoglycemia in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: This was a 4-week randomized, controlled crossover trial of 2-week MDG or 2-week oral glucose tablets (OG, control) involving 17 adults with T1D during Ramadan. RESULTS: Compared with OG, MDG demonstrated a significant higher change in blood glucose from baseline to 30 min (Δ(t)(30), P < 0.001) and 1 h (Δ(t)(60), P = 0.02). The efficacy of MDG was preserved following ≥8 h fasting with significantly higher Δ(t)(30) in MDG (P = 0.01). Over the entire 2 weeks, MDG period had increased time in 70–180 mg/dL (P = 0.009) and less time <70 mg/dL (P = 0.04). MDG use resulted in higher completion of fasts compared with OG (P < 0.001). CONCLUSIONS: MDG administration is an effective alternative to OG for prevention and treatment of fasting-induced hypoglycemia, offering improved glycemic control and promoting successful completion of prolonged fasts.