Practice makes perfect: Utilizing the Glucagon app to practice for a hypoglycemic emergency

Patient Centric App Review Series

App Reviewed: Glucagon (Ver. 1.01)

Goals of app review:

  • Assess effectiveness of app in educating patients on administration of glucagon during hypoglycemia events
  • This review will not address specifics of Glucagon therapy, rather it will concentrate on the education of proper administration of the medication

Introduction:

Hypoglycemia management can be complicated depending on the severity of the situation. Due to increased risk for morbidity and mortality, prompt treatment is important. [1] Patients who do not respond to oral management and become unresponsive will require an increased level of care.

However, during management in an outpatient setting, treatment is limited. Glucagon for injection (rDNA origin) is often prescribed for patients at high risk for hypoglycemia, and has high utilization during emergency situations. [2]

While the use of Glucagon by caregivers may help mitigate hypoglycemia prior to professional care, it has been demonstrated to be underutilized. [3] Reasons for Glucagon’s underutilization stems from caregivers lack of confidence in proper use. This could be secondary to poor education on proper administration causing hesitancy in preparation and injection during an acute event. [4,5]

App Specifics:
Last Updated: September 6, 2012
Compatibility: iPhone, iPad, iPod Touch
Requires: iOS 4.3 or later
Reviewed on:  iPhone 4

Eli Lilly created the Glucagon app to help educate patients, caregivers, and providers on proper preparation and administration techniques. It is important to realize that without proper education and technique, the administration of Glucagon can be daunting. Often, those that may be required to inject the medication require some form of instruction upon prescribing in order to understand proper use.

However, it could be lengths of time before a caregiver may be called upon to administer Glucagon, and caregivers may have forgotten proper use. Use of a tool to help caregivers review administration may be beneficial, especially if required during an acute event.

The app initially opens up with the traditional ‘Terms of Agreement’ and ‘Important Safety Information’ upon start-up. After agreeing to terms of use, the app starts up with a simple menu detailing several options. The most important one though is ‘Emergency Instructions.’

Initiating the Emergency Instructions will start a step-by-step guide on the preparation and administration of Glucagon. It is important to note that the instructions provided are essentially the same as the instructions provided by Eli Lilly for patients.

What is nice about the instructions provided in the app, though, is that they are illustrated and have an accompanying voice telling the user what to do. One thing that could be improved would be an ability to pause or repeat instructions during the demonstration.


Another great feature of the app is the ability to ‘practice’ administration of Glucagon with the ‘Practice and Prepare’ option. Starting this feature will give the user the ability to follow along with administration of the medication. This is accomplished by swiping on screen for key steps (e.g. flipping of the vial top, shaking the vial, filling the syringe).

This is a nice and fun feature to help a caregiver learn the key steps of preparation and administration of Glucagon.


Lastly, the app has the ability to record the expiration dates of Glucagon kits along with their locations. This may be beneficial if a patient has multiple kits at different locations (e.g. office, school) and unsure of when to get a refill. There is also attached patient and provider information supplied by Eli-Lilly that is the same as their paper handouts.

Healthcare Goals:

The Glucagon app seeks to help caregivers gain a better grasp on proper preparation and administration of Glucagon during acute events of hypoglycemia.

Evidence to Support Goals:

Currently there is no information supporting the use of educational apps in improving patient outcomes associated with hypoglycemia (search terms on pubmed: education app, hypoglycemia, hypoglycemia app, glucagon).

However, due to earlier studies addressing shortage of use of Glucagon, this app may help overcome caregivers hesitancy with utilization due to lack of confidence. [4,5] The educational benefit of this app may help improve caregivers confidence in their ability to prepare and inject the medication. Additionally, the step-by-step instructions provided within the app may also help direct caregivers on what to do in an urgent situation, similar to what a defibrillator device does.

Price:

  • Free

Likes:

  • Tool that helps address the need for proper education for an important medication
  • Interactive teaching on use and administration
  • Step-by-Step instructions on utilization
  • Ability to record medication and expiration dates for reminders
  • Reminder system to alert caregivers to brush up on technique

Dislikes:

  • Step-by-Step instructions should have pause button or repeat for each step, instead of streaming continuously
  • General instructions for hypoglycemia or background education may be beneficial for patients overall
  • Not supported on Android devices

What type of provider may benefit from this app?

  • Primary Care Providers
  • Endocrinologists
  • Pharmacists
  • Diabetes Educators
  • Family Members of Patient
  • Care Provider of Patient

What type of patient may benefit from this app?

  • Those that require Glucagon
  • Providers that enjoy having a mobile tool for education

Conclusions:

  • Glucagon app may be beneficial as an educational tool for caregivers that may be required to administer Glucagon during hypoglycemia.
  • Pros – Audio/Visual demonstration on administration of glucagon, as well as a interactive educational activity
  • Cons – Would be beneficial to stop/pause instructions during use, and inclusion on Android devices would be an improvement

Bottom Line:

The Glucagon app may be a great app for patients prescribed glucagon to help educate caregivers that may be required to prepare and inject the medication. The instructions and interactive tools provided in the app should be emulated by other app developers, and could be utilized by other manufacturers to help educate patients and providers.

iTunes Link

References:

  1. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26(6):1902-12.
  2. Brackenridge A, Wallbank H, Lawrenson RA, Russell-Jones D. Emergency management of diabetes and hypoglycaemia. Emerg Med J. 2006;23(3):183-5.
  3. Kedia N. Treatment of severe diabetic hypoglycemia with glucagon: an underutilized therapeutic approach. Diabetes Metab Syndr Obes. 2011;4:337-46.
  4. Yardley D, Lyddall A, Richardson J, et al. Glucagon injection for type 1 diabetes in children. Nurs Child Young People. 2011;23(9):12-8.
  5. Pearson T. Glucagon as a treatment of severe hypoglycemia: safe and efficacious but underutilized. Diabetes Educ. 2008 Jan-Feb;34(1):128-34.


Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.

Author:

Timothy Aungst, PharmD

Digital Pharmacist seeking to integrate technology and mHealth into pharmacy practice and patient care. Assistant Professor by day, blogger and writer by night.

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