Can Mini-Dose Glucagon Prevent Fasting-Induced Hypoglycemia and Preserve Fasting?

TL;DR

This paper reviews whether a small dose of glucagon can help prevent low blood sugar during fasting in people with diabetes without breaking their fast.

Contribution

The paper synthesizes limited evidence on mini-dose glucagon for managing hypoglycemia during fasting, highlighting gaps in current research.

Findings

Mini-dose glucagon may be feasible for short-term mild hypoglycemia correction during fasting.

Current evidence is limited by small sample sizes and inconsistent study designs.

Larger studies are needed to confirm safety and efficacy of mini-dose glucagon during fasting.

Abstract

Individuals with diabetes, particularly those using insulin, face substantial challenges when fasting during the Islamic month of Ramadan due to prolonged periods without food or drink and an increased risk of hypoglycemia. Mini-dose glucagon (MDG) has been considered as an alternative to oral carbohydrate intake for mild or impending hypoglycemia without breaking the fast; however, current evidence is limited and remains preliminary, derived largely from small pilot studies and limited real-world data.

This hypothesis-generating review synthesizes findings from a pilot RCT (n=17), an observational survey (n=136), and a focused literature search, providing the reader with the best evidence so far on this topic. Across the available evidence, MDG appears feasible for short-term correction of mild hypoglycemia, yet its efficacy, safety, and optimal dosing during fasting remain insufficiently established. Limitations of the present studies, such as small sample sizes, investigators' involvement, and heterogeneity in study designs, suggest cautious interpretation.

Considering the relatively early nature of the evidence and the importance of patient safety at fasting times, the use of MDG cannot be regarded as a proven or routine strategy. Larger, independently conducted studies are required to clarify its clinical role, validate dosing protocols, and ensure alignment with safety-first recommendations for fasting individuals with diabetes.

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