Pharmacy professors working to increase takeup of life-saving drug

By Chuck Gordon

Insulin is a life-saving drug for many patients with diabetes, but one potential side effect - a drop in blood sugar, also known as hypoglycemia - can be deadly. The body's organs, including the brain, can malfunction if deprived of the right amount of glucose.

Glucagon is a proven, though underused, antidote to hypoglycemia. Much like Naloxone does for fentanyl overdoses, glucagon can stabilize patients with dangerously low blood sugar.

Glucagon has been around for decades, and legislation in 2021 made it easier for pharmacists in North Carolina to prescribe it. But a year or so after that legislation was enacted, Dr. Shawn Taylor, a clinical pharmacist practitioner in Asheville and a professor in the Wingate University School of Pharmacy, hadn't noticed any increased use of it.

She checked her health organization's database and found that the ratio of insulin prescriptions to glucagon prescriptions was a whopping 300-to-1. "It was staggering," she says. "Everybody on insulin deserves to have access to glucagon."

Taylor enlisted the help of three of her colleagues, and they started investigating further, taking data from the North Carolina Medicaid database and running statistical analyses. The result was "Geographic Disparities in Glucagon Prescriptions in North Carolina," a paper recently published in the American Journal of Preventive Medicine that confirmed Taylor's initial research.

The WUSOP group - Taylor and fellow faculty members Dr. Edward Chiyaka, Dr. Evan Drake and Dr. Michelle Chaplin - researched the number of Medicaid claims for insulin and glucagon prescriptions between January 2022 and July 2023. Across the state, rates of insulin prescription claims were notably higher than rates of glucagon prescription claims, particularly in rural counties. In urban counties, there were 18.3 insulin claims per 1,000 adults, compared with 2.6 for glucagon. In rural counties, the difference was even more drastic: 27.7 (insulin) vs. 2.8 (glucagon). In 38 North Carolina counties, zero glucagon claims were found over the study period.

The numbers are startling. "The American Diabetes Association tells us that anybody who's at risk for hypoglycemia should have access to glucagon," Taylor says. "It's like having an EpiPen if you have an allergy to something."

Lack of glucagon access is not just a state or regional problem. A cohort study revealed that between 2011 and 2021, less than 4 percent of patients with diabetes who were at high risk of hypoglycemia were prescribed the drug. Compounding the problem is that glucagon is much less likely to be available or prescribed in rural areas, where diabetes is much more prevalent. The diabetes rate in North Carolina was 12.4 percent in 2022, but it varies widely between urban and rural counties. For instance, in 2017 in Mecklenburg County, home to 1.1 million people, 8.3 percent of people ages 20 and older had been diagnosed with diabetes. In rural Hertford County, home to fewer than 24,000 people, the rate was 22.4 percent.

Follow-up study

After their initial research turned up such huge disparities in glucagon takeup, the WUSOP foursome turned to finding out why. A second paper authored by the quartet and due to be published this fall will detail barriers keeping patients with diabetes in the state from having access to glucagon. The researchers surveyed a dozen pharmacies and prescribers to find out what was inhibiting glucagon use. Cost, access and misinformation were the primary reasons.

Taylor says that one barrier is that caregivers and family members don't always feel comfortable loading a syringe and injecting a loved one who is crashing with hypoglycemia. Pharmacists might be reluctant to prescribe it because insurance primarily reimburses them for the cost of the drug - or for most of it, anyway - but not for the time spent educating their patients and caregivers, which can be considerable.

Even hospitals aren't always doing their part. In the United States, nearly one-tenth of emergency-department visits that have been attributed to an adverse drug event are insulin-related hypoglycemia. And yet, Taylor says, "There are people being admitted to emergency rooms for hypoglycemia that get discharged without glucagon. It's baffling. They revive them. They get them stable. But they discharge them home. … We're missing a step that is critical."

The next step for the Wingate group is to solicit grant funding to develop an initiative to spread the word about how important glucagon is, especially in rural areas. Greater information - not to mention advances in technology that make the administration of the drug much easier - should change people's minds.

"There aren't needle-phobias when it saves your life," Taylor says. "You find your loved one there passed out - sure, call 911, but call 911 at the same time that you're giving an injection of glucagon. That's only going to revive them for a short amount of time, and you need help on the way. But that could save their life."

July 8, 2025