Does Zegalogue need to be mixed?

No. It comes ready to inject in an autoinjector or prefilled syringe. A standard glucagon emergency kit has to be mixed from powder and liquid first.

How long do you hold the Zegalogue autoinjector?

The Instructions for Use say to press it down and count slowly to 10 seconds, until the medicine window turns red.

What is the Zegalogue dose for a child?

The same as for adults: 0.6 mg for everyone aged 6 and older. A glucagon kit uses half a dose (0.5 mg) for children under 44 lb.

Why turn someone on their side after glucagon?

Both instructions say people may vomit when they wake up, and lying on their side helps prevent choking.

How to Use Zegalogue vs a Glucagon Mixing Kit

Short answer: Zegalogue comes ready to inject: pull off the gray cap, press the autoinjector on bare skin and hold for 10 seconds until the window turns red. A glucagon emergency kit has to be mixed first: inject the liquid from the syringe into the powder vial, swirl until clear, draw it back up and inject. After either, both instructions say to turn the person on their side, call for emergency help, and give food once they can swallow.

Zegalogue: ready to inject

Zegalogue (dasiglucagon) treats severe low blood sugar in people with diabetes aged 6 and older. Every age gets the same dose, 0.6 mg, in an autoinjector or a prefilled syringe. The Instructions for Use list the outer upper arms, lower abdomen (at least 2 inches from the belly button), front or back of the thighs, and buttocks, and say not to inject through clothes.

Hold the red protective case upright with the gray lid or cap on top and pull it up to open the case.
Autoinjector: pull the gray cap straight off, keeping fingers away from the yellow needle guard. Prefilled syringe: pull the gray needle cover straight off without bending the needle.
Autoinjector: push it straight down on the skin until the yellow guard is pressed in, then hold and count slowly to 10. The window turns red when the full dose is in. Prefilled syringe: pinch the skin, insert the whole needle at a 45° angle, let go of the pinch and push the plunger all the way down.
Lift the device straight up. The yellow guard on the autoinjector covers the needle and locks.

A glucagon emergency kit: mix first

A standard glucagon kit, such as the Amphastar Glucagon Emergency Kit, holds a vial of 1 mg glucagon powder and a prefilled syringe of liquid (diluent). The Instructions for Use say not to mix it with any other liquid.

Flip off the vial seal and wipe the rubber stopper.
Take the cover off the syringe needle and inject all the liquid into the powder vial.
Swirl gently until the powder has fully dissolved and the liquid is clear. Do not use it if it is cloudy or has particles.
With the vial upside down and the needle in the liquid, draw it all back up (the 1 mg mark). For children under 44 lb (20 kg), draw up half (0.5 mg).
Inject into the buttock, upper arm or thigh, then press lightly on the site as the needle comes out.

The mixed glucagon is used right away and any leftover is thrown out. The kit label allows injection under the skin or into muscle.

After the shot

Both sets of instructions give the same next steps. Turn the person on their side, because people waking from a severe low may vomit; nausea was reported in 57% of adults within 12 hours of Zegalogue in its trials, and vomiting in 25%. Call for emergency help right away, even if the person wakes up. If there is no response after 15 minutes, another dose may be given while waiting; for Zegalogue, the label says from a new device. Once the person can swallow safely, give a fast sugar such as juice and then a longer-lasting snack such as crackers with cheese or peanut butter.

In the Zegalogue label trials in adults with type 1 diabetes, the median time for blood sugar to rise by at least 20 mg/dL was 10 minutes on Zegalogue vs 35 to 40 minutes on placebo. The label table compares Zegalogue only with placebo.

Storage and replacing

Storage (labels and Instructions for Use)
	Zegalogue	Glucagon emergency kit (Amphastar)
Where	Refrigerator, 36 to 46°F, in the red case	Room temperature, 68 to 77°F, in its package away from light
Room temperature	Up to 12 months; write the date on the case and do not put it back in the fridge	Already stored at room temperature
Freezing	Do not freeze	Do not freeze
Latex	The gray cap or needle cover contains dry natural rubber	Not stated

The Zegalogue instructions say to replace a used device right away so there is always one on hand. Dose Track can keep a rescue medicine with its expiry date and the date it left the fridge, and log any dose given, so the prescriber can see how often severe lows happen.

General education drawn from labels, public health agencies and published studies, not personal medical advice. Your prescriber, pharmacist and the label that came with your medicine are the final word. Questions for other users? Ask in the Dose Track community.

Frequently asked questions

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