Mini-Dose Glucagon to Treat Non-Severe Hypoglycemia
Mini-Dose Glucagon to Treat Non-Severe Hypoglycemia
The purpose of this study is to determine if a small dose of glucagon (mini-dose glucagon) is
 effective for the treatment of non-severe hypoglycemia in adults with type 1 diabetes (T1D).
There are three phases included in this study: (1) Pre-crossover Trial Run-in Phase, (2)
 Randomized Clinical Trial (RCT) Crossover Trial Phase, and (3) Post-Crossover Trial Extension
 Phase.

 1. Run-in Phase:

 Prior to commencing the crossover trial, study enrollment will begin with a 2 week
 run-in phase to assess hypoglycemia eligibility and compliance.

 2. Crossover Trial Phase:

 The Crossover Trial Phase will consist of two (3-week) periods.

 The Crossover Trial Phase will include up to 24 participants who complete these study
 periods. Participants who do not complete both periods or who do not have at least one
 event during both periods may be replaced.

 During the Crossover Trial Phase participants will be randomized into two groups: (1)
 Group A will use mini-dose glucagon in period 1 and oral glucose tablets in period 2 and
 (2) Group B will use oral glucose tablets in period 1 and mini-dose glucagon in period
 2. Each group with follow the applicable treatment arm according to their randomized
 group.

 3. Extension Phase:

 The Post-Crossover Trial phase will commence upon completion of the second 3-week period of
 the Crossover Trial Phase. Participants will have a 3 week phase during which time they will
 decide whether to use mini-dose glucagon or glucose tablets to treat each non-severe
 hypoglycemic event or to prevent hypoglycemia.
Inclusion Criteria:

 1. Clinical diagnosis of presumed autoimmune T1D and receiving daily insulin

 2. Age: 18.0 to < 65.0 years

 3. Duration of T1D: ≥2.0 years

 4. Body mass index 20.0 to <35.0 kg/m2 and weight 110 to <250 lbs

 5. HbA1c <8.5% (point of care or local lab, within past month)

 6. Using continuous subcutaneous insulin infusion (CSII) therapy (i.e., insulin pump) for
 at least 3 months, with no plans to discontinue use during the study (and no use of
 active low glucose suspend feature within the last 4 weeks)

 7. Using continuous glucose monitor ≥6 days/week in the last 4 weeks, with no plans to
 discontinue continuous glucose monitor use during the study

 8. Continuous glucose monitor glucose level <70 mg/dl during daytime hours (e.g., 8am -
 10pm) on at least 7 of the past 28 days (a modification can be made for participants
 with non-traditional waking hours) evaluated from downloaded CGM data

 9. Females must meet one of the following criteria:

 -  Of childbearing potential and not currently pregnant (negative pregnancy test) or
 lactating, and agrees to use an accepted contraceptive regimen as described in
 the study procedure manual throughout the entire duration of the study (from
 screening visit until study completion); or

 -  Of non-childbearing potential, defined as a female who has had a hysterectomy or
 tubal ligation, is clinically considered infertile or is in a menopausal state
 (at least 1 year without menses)

 10. In good general health with no conditions that could influence the outcome of the
 trial, and in the judgment of the investigator is a good candidate for the study based
 on review of available medical history, physical examination and clinical laboratory
 evaluations

 11. Willing to adhere to the protocol requirements for the duration of the study

 12. Participant has a smart phone available and is able to use it daily

 13. Must be enrolled in the T1D Exchange clinic registry or willing to join the clinic
 registry

 Exclusion Criteria:

 1. More than 1 severe hypoglycemic episode in the past 12 months (as defined by an
 episode that required third party assistance for treatment)

 2. More than 1 episode of diabetic ketoacidosis in the past 12 months (as defined by an
 episode diagnosed as diabetic ketoacidosis that required treatment in an emergency
 department or hospitalization)

 3. Presence of cardiovascular, gastrointestinal, liver or kidney disease, or any medical
 condition which, in the judgment of the investigator, could potentiate or predispose
 to undesired effects or could interfere with the absorption, distribution, metabolism,
 or excretion of glucagon or ability to respond appropriately to mild to moderate
 hypoglycemia.

 4. Known presence of hereditary problems of glycogen storage disease, galactose and/or
 lactose intolerance

 5. Males with alcohol use in excess of 3 or more drinks per day, on average and females
 with alcohol use in excess of 2 or more drinks per day, on average

 6. Use of non-insulin anti-diabetic medications

 7. Use of daily systemic beta-blocker

 8. Use of beta-adrenergic agonists, theophylline (or other methylxanthines)

 9. Use of 1st generation anticholinergic drugs (such as Brompheniramine,
 Chlorpheniramine, Dimenhydrinate, Diphenhydramine, and Doxylamine)

 10. Use of systemic corticosteroids

 11. History of hypersensitivity to glucagon or any related product or excipient or severe
 hypersensitivity reactions (such as angioedema) to any drugs

 12. History of epilepsy or seizure disorder

 13. Uncontrolled hypertension, >160 mmHg systolic or >100 mmHg diastolic

 14. Currently a high endurance exerciser or plans to perform high endurance exercise
 during study (from screening visit until study completion)

 -  High endurance exerciser defined as a person who regularly competes in running,
 cycling, rowing, swimming or any other endurance-based activity for the purpose
 of competition (>2100 metabolic equivalent of task (MET) minutes per week [i.e. 7
 METs x 60 minutes x 5 days a week, where 7 METs is equivalent to jogging])

 15. Currently following a very low calorie or other weight-loss diet

 16. Participation in other studies involving administration of an investigational drug or
 device within 30 days or 5 half-lives, whichever is longer, before screening for the
 current study or planning to participate in another such study during participation in
 the current study