Introduction
Zegalogue (dasiglucagon) is a glucagon analog injection indicated for the treatment of severe hypoglycemia. Developed by Zealand Pharma, it represents a significant advancement in hypoglycemia management with its ready-to-use formulation and rapid onset of action. Unlike traditional glucagon kits that require reconstitution, Zegalogue comes as a prefilled syringe or auto-injector, making it more accessible for emergency use.
Mechanism of Action
Zegalogue is a synthetic analog of human glucagon that binds to and activates glucagon receptors in the liver. This activation stimulates hepatic glycogenolysis and gluconeogenesis, resulting in rapid elevation of blood glucose levels. As a peptide hormone, dasiglucagon counteracts the effects of insulin by promoting the breakdown of glycogen to glucose in hepatocytes and increasing hepatic glucose production from amino acid precursors.
Indications
Zegalogue is FDA-approved for:
- Treatment of severe hypoglycemia in pediatric and adult patients with diabetes aged 6 years and older
- Use in emergency situations when the patient cannot take oral carbohydrates
Dosage and Administration
Standard dosing:- Adults and pediatric patients ≥6 years: 0.6 mg subcutaneous injection
- Administer into the abdomen, thigh, or upper arm
- Use immediately after removal from pouch
- Do not test before use
- Renal impairment: No dosage adjustment necessary
- Hepatic impairment: No specific recommendations (use with caution)
- Geriatric patients: No dosage adjustment required
Pharmacokinetics
Absorption: Rapid subcutaneous absorption with median Tmax of 15 minutes Distribution: Limited tissue distribution due to peptide nature Metabolism: Proteolytic degradation similar to endogenous glucagon Elimination: Half-life of approximately 25-30 minutes Bioavailability: Complete following subcutaneous administrationContraindications
- Known hypersensitivity to dasiglucagon or any component of the formulation
- Pheochromocytoma
- Insulinoma
- Glucagonoma
Warnings and Precautions
Hypersensitivity reactions: May occur, including anaphylaxis Glycogen depletion: Effectiveness depends on adequate hepatic glycogen stores Hyperglycemia: May occur after recovery from hypoglycemia Pregnancy: Use only if clearly needed (Category B) Pediatric use: Safety established in patients ≥6 years Hepatic impairment: Use with caution due to potential for altered responseDrug Interactions
- Beta-blockers: May blunt the hyperglycemic response
- Indomethacin: May prolong hyperglycemic effect
- Anticholinergic agents: May increase gastrointestinal side effects
- Insulin: Antagonistic effect (concurrent use not recommended)
Adverse Effects
Common (≥2%):- Nausea (19%)
- Vomiting (6%)
- Headache (5%)
- Injection site reactions (4%)
- Diarrhea (3%)
- Hypersensitivity reactions
- Severe hypertension (rare)
- Hypoglycemia rebound (theoretical)
Monitoring Parameters
- Blood glucose levels before and after administration
- Vital signs during and after treatment
- Signs of hypersensitivity reactions
- Resolution of hypoglycemic symptoms
- Post-treatment hyperglycemia monitoring
Patient Education
Key points for patients and caregivers:- Use only for severe hypoglycemia when oral carbohydrates cannot be taken
- Recognize symptoms of severe hypoglycemia (confusion, unconsciousness, seizures)
- Administer immediately and seek emergency medical attention
- Train proper injection technique using trainer device
- Rotate injection sites
- Store at room temperature (up to 25°C/77°F)
- Check expiration date regularly
- Inform healthcare providers about all medications
- Always have a replacement available
- Turn patient on side to prevent aspiration if vomiting occurs
- When conscious, provide fast-acting carbohydrate followed by snack or meal
- Monitor blood glucose for several hours after recovery
References
1. FDA prescribing information: Zegalogue (dasiglucagon) injection. 2021 2. Pieber TR, et al. Dasiglucagon for the treatment of insulin-induced hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2021;44(12):2657-2665 3. Haahr H, Heise T. A review of the pharmacological properties of dasiglucagon. Diabetes Ther. 2021;12(5):1303-1313 4. Mathieu C, et al. Efficacy and safety of dasiglucagon for treatment of hypoglycemia in type 1 diabetes. J Clin Endocrinol Metab. 2020;105(7):dgaa217 5. American Diabetes Association. Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S1-S291
This monograph is intended for educational purposes only and should not replace clinical judgment. Always consult the full prescribing information and current clinical guidelines.