What Is Dasiglucagon (Zegalogue)? The Ready to Use Glucagon Peptide for Severe Low Blood Sugar and What Its Trials Found

Dasiglucagon is a 29 amino acid peptide analog of glucagon, the hormone that tells the liver to release stored sugar, and it is sold as Zegalogue for severe hypoglycemia in people with diabetes. Dasiglucagon comes as a single 0.6 mg dose in an autoinjector or prefilled syringe that a caregiver or bystander can inject under the skin without mixing anything first. The [Zegalogue label](https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/214231s004lbl.pdf) lists an initial U.S. approval in 2021, and its June 2026 revision covers adults and children with diabetes who weigh at least 20 kg.

Native glucagon is a notoriously unstable peptide in water, which is why the classic glucagon emergency kit ships as a powder that has to be dissolved in a syringe of liquid during the emergency itself. Dasiglucagon was engineered to stay dissolved and stable in solution. This article explains what dasiglucagon is and how it works, walks through what the adult, pediatric and autoinjector trials found, and then covers how it compares with other rescue glucagon products, which side effects to expect, and where the research is heading. It is educational content about published research, not medical advice.

Severe hypoglycemia is a low blood sugar episode in which a person is too confused, drowsy or unconscious to treat themselves and needs someone else's help. Severe hypoglycemia is most common in people who use insulin, especially people with type 1 diabetes, because injected insulin keeps lowering glucose even when the body no longer needs it to.

The usual fix for low blood sugar is fast carbohydrate by mouth, but that stops working once a person cannot swallow safely. At that point the options are intravenous glucose, which needs a paramedic or a hospital, or glucagon, which a family member, teacher or coworker can give. Glucagon raises blood sugar by signaling the liver to break down its stored glycogen and push glucose into the blood.

The weak point has always been the delivery. A traditional glucagon emergency kit asks a frightened bystander to inject liquid into a vial of powder, mix it, draw it back up and inject it, all while someone is seizing or unresponsive. Ready to use glucagon products, including nasal glucagon, a stable liquid glucagon sold as Gvoke, and dasiglucagon, were developed to remove those steps.

Dasiglucagon works the way the body's own glucagon does, by binding glucagon receptors on liver cells and triggering glycogen breakdown and glucose release. The Zegalogue label describes dasiglucagon as a glucagon receptor agonist that increases blood glucose "by activating hepatic glucagon receptors, thereby stimulating glycogen breakdown and release of glucose from the liver."

Because dasiglucagon depends on the liver's sugar stores, it cannot work when those stores are empty. The label warns that people in states of starvation, with adrenal insufficiency or with chronic hypoglycemia may not have enough hepatic glycogen for it to be effective, and those people should be treated with glucose instead.

The label's pharmacology section gives the time course. After a 0.6 mg injection, dasiglucagon reaches a mean peak plasma concentration of 5110 pg/mL at around 35 minutes, and its half life is approximately 30 minutes. In adults with type 1 diabetes, mean blood glucose rose by 168 mg/dL at 90 minutes, while in children aged 6 to 17 the mean rise was 162 mg/dL at 60 minutes.

Dasiglucagon is a modified version of human glucagon. Like glucagon, dasiglucagon is a 29 amino acid peptide, and the Zegalogue label gives a molecular mass of 3382 g/mol. The developer, Zealand Pharma, modified the glucagon sequence so the peptide stays soluble and stable in an aqueous formulation, something native glucagon cannot do as a stored liquid.

That stability is the whole point of the molecule. The first human pharmacology study ([Hövelmann and colleagues, Diabetes Care, 2018](https://doi.org/10.2337/dc17-1402)) described dasiglucagon as "a novel soluble glucagon analog" and tested it against GlucaGen, a reconstituted glucagon, in 58 people with type 1 diabetes. Single doses of 0.1, 0.3, 0.6 or 1.0 mg dasiglucagon raised plasma glucose by at least 20 mg/dL within 9 to 14 minutes, similar to GlucaGen, with a longer lasting effect on glucose. Nausea was the most frequent side effect and occurred at a similar rate in both groups, between 44% and 56%.

The result is a rescue peptide that sits in a red protective case as a clear liquid, ready to inject. If you are interested in how other approved peptides were reengineered for stability and dosing, the [pramlintide (Symlin) article](/articles/pramlintide-symlin-amylin-analog) covers a similar story for the hormone amylin.

The main adult approval trial showed that dasiglucagon brought blood sugar back up in a median of 10 minutes, compared with 40 minutes on placebo. Pieber and colleagues published the results in [Diabetes Care in 2021](https://doi.org/10.2337/dc20-2995), and the FDA label calls it Trial A.

The design was a controlled hospital experiment rather than a real world emergency. Investigators gave 170 adults with type 1 diabetes an intravenous insulin infusion to push their glucose down, then randomized them 2:1:1 to a single subcutaneous injection of 0.6 mg dasiglucagon, placebo or 1 mg reconstituted glucagon. The label reports a mean baseline plasma glucose of 59 mg/dL and a mean age of 39, and the primary endpoint was time to plasma glucose recovery, defined as a rise of at least 20 mg/dL without needing rescue intravenous glucose.

The paper's abstract states that "plasma glucose recovery was achieved within 15 min in all but one participant (99%)." By that 15 minute mark, only 2% of the placebo group and 95% of the reconstituted glucagon group had recovered.

The formal statistical test compared dasiglucagon with placebo only. The label notes there was no formal hypothesis test of dasiglucagon versus glucagon, so the 10 versus 12 minute difference should be read as similar rather than better.

The autoinjector beat placebo by the same margin in a second adult phase 3 trial, with a median recovery time of 10 minutes, matching the syringe result from Trial A. Bailey and colleagues ([Diabetes, Obesity and Metabolism, 2021](https://doi.org/10.1111/dom.14475)), Trial B in the label, randomized 45 adults with type 1 diabetes 3:1 to dasiglucagon 0.6 mg by autoinjector or placebo after induced hypoglycemia.

Median time to recovery was 10.0 minutes on dasiglucagon versus 35.0 minutes on placebo, and by 15 minutes 88% of people on dasiglucagon had recovered compared with none on placebo. The injection site made no measurable difference, since the buttock and the deltoid gave similar recovery times, and no serious adverse events occurred.

A separate device study ([Bailey NC and colleagues, Diabetes Technology and Therapeutics, 2022](https://doi.org/10.1089/dia.2021.0367)) asked whether real people can actually use the device under pressure. Trained caregivers and untrained bystanders treated a manikin in a simulated emergency using either the dasiglucagon autoinjector or a traditional glucagon emergency kit.

Among the 54 participants, most (94%) preferred the autoinjector and 90% rated it easier to use. The [subcutaneous injection technique guide](/articles/peptide-injection-site-subcutaneous-technique) explains why the abdomen, thigh, buttock and upper arm are the standard sites for this kind of injection.

Dasiglucagon worked as well in children and teenagers aged 6 to 17 as it did in adults. Battelino and colleagues ([Pediatric Diabetes, 2021](https://doi.org/10.1111/pedi.13220)), Trial C in the label, randomized 42 children and adolescents with type 1 diabetes 2:1:1 to dasiglucagon 0.6 mg, placebo or reconstituted glucagon dosed per label during insulin induced hypoglycemia.

Median time to recovery was 10 minutes for dasiglucagon versus 30 minutes for placebo. Reconstituted glucagon also took a median of 10 minutes, although the authors note that this figure "did not include the time taken to reconstitute the lyophilized powder." Every child on dasiglucagon or glucagon recovered within 20 minutes, compared with 2 of 11 (18%) on placebo.

The June 2026 label revision moved the pediatric threshold from age to body weight, so Zegalogue is now indicated for children with diabetes who weigh at least 20 kg (44 pounds), and the label states that safety and effectiveness have not been established below 20 kg.

Nausea and vomiting are the main side effects of dasiglucagon, as they are with every form of glucagon. The label's adult data come from 116 people on dasiglucagon and 53 on placebo in the two placebo controlled trials, counting reactions within 12 hours of the dose.

Teenagers had more stomach upset than younger children. In the pediatric trial, nausea occurred in 65% of all children on dasiglucagon, split between 25% of those aged 6 to 11 and 92% of those aged 12 to 17, and vomiting followed the same pattern at 50% overall, 25% in the younger group and 67% in the older group.

An integrated analysis of the adult program ([Heller and colleagues, Diabetes, Obesity and Metabolism, 2023](https://doi.org/10.1111/dom.14987)) found that in the placebo controlled data "no serious adverse events (AEs), AEs leading to withdrawal from the trial, or deaths were reported." The most common treatment related effects in that analysis were nausea (56.5%) and vomiting (24.6%), which is in line with the label.

The label contraindicates dasiglucagon in people with pheochromocytoma, because it may trigger a dangerous release of adrenaline like hormones from the tumor, and in people with insulinoma, because it can provoke a rebound insulin surge and a second low. The label also warns that dasiglucagon may increase the effect of warfarin and may lose its effect in people taking indomethacin.

Zegalogue is a single 0.6 mg dose for every adult and child who weighs at least 20 kg. The label instructs the person giving it to inject into the lower abdomen, buttocks, thigh or outer upper arm, to call for emergency help right away, and to give oral carbohydrates once the patient responds. If there has been no response after 15 minutes, a second 0.6 mg dose from a new device may be given while waiting for help.

Storage is where dasiglucagon differs most from the old kits. Zegalogue is stored in a refrigerator at 2°C to 8°C (36°F to 46°F), but it can be kept at room temperature between 20°C and 25°C (68°F to 77°F) for up to 12 months. Once it is out of the fridge it should not go back in, and it should be discarded after the 12 month room temperature window.

No head to head trial has compared the three ready to use glucagon products directly, so the best available comparison is an indirect one. Giménez and colleagues ([Diabetes Therapy, 2023](https://doi.org/10.1007/s13300-023-01466-6)) pooled 10 clinical trials of Baqsimi (nasal glucagon), Gvoke (liquid glucagon) and Zegalogue, each tested against reconstituted glucagon, and found that all three achieved treatment success above 98%.

Several authors of that analysis were Eli Lilly employees, and indirect comparisons carry more uncertainty than direct trials. For a family choosing a rescue product, the practical differences tend to be the route (nose versus injection), the minimum age or weight on each label, storage rules and insurance coverage, rather than large differences in how fast blood sugar comes up.

Researchers are testing dasiglucagon in conditions where repeated or continuous glucagon could prevent lows, although none of these uses is approved.

Congenital hyperinsulinism (CHI) is a rare condition in which a baby's pancreas releases too much insulin, causing repeated lows that can damage the brain. In a randomized phase 3 trial ([Thornton and colleagues, Journal of Clinical Endocrinology and Metabolism, 2024](https://doi.org/10.1210/clinem/dgad648)), 32 children aged 0.6 to 10.9 years received standard care with or without a continuous infusion of dasiglucagon under the skin (10 to 70 µg/h) for 4 weeks. The primary endpoint, hypoglycemia detected by finger stick, did not differ significantly (event rate ratio 0.85), while a post hoc analysis of continuous glucose monitor data found a 43% reduction in hypoglycemia. Regulators have not approved this use, and the trade outlet [pharmaphorum reported in October 2024](https://pharmaphorum.com/news/fda-knocks-back-zealands-dasiglucagon-once-again) that the FDA had issued a second complete response letter, citing a third party manufacturing site.

Some people develop dangerous lows after meals following Roux-en-Y gastric bypass. In a crossover trial of 24 such patients ([Nielsen and colleagues, Diabetes Care, 2023](https://doi.org/10.2337/dc23-1193)), 4 weeks of self injected 120 µg dasiglucagon reduced time in level 1 hypoglycemia by 33% and time in level 2 hypoglycemia by 54% compared with placebo.

A small phase 2 crossover trial ([Laugesen and colleagues, Diabetologia, 2023](https://doi.org/10.1007/s00125-023-05909-4)) gave 24 adults on insulin pumps a pen with an 80 µg dose to use instead of carbohydrates for mild lows over 2 week periods. Mild nausea was the most common side effect, and 96% of participants said they were likely to use it in the future. These are small studies, and low dose dasiglucagon pens are not an approved product.

The core evidence for dasiglucagon is strong for what it was designed to show and narrow beyond that. The three approval trials all used controlled, insulin induced hypoglycemia in a clinic, in people with type 1 diabetes, with trained staff giving the injection, whereas real emergencies involve type 2 diabetes, older adults, panicked bystanders and unknown amounts of liver glycogen.

The trials also measured a lab endpoint, a 20 mg/dL rise in glucose, rather than outcomes such as avoiding an ambulance ride, a seizure or a hospital admission. Most of the approval studies were funded by Zealand Pharma, and several authors were company employees. None of this undermines the core finding that dasiglucagon raises blood sugar quickly and reliably, but it is worth knowing what the trials did and did not test. If you or someone you live with uses insulin, your prescriber is the right person to talk with about hypoglycemia risk, and the [peptide blood work guide](/articles/peptide-protocol-blood-work-biomarker-monitoring) explains which labs are commonly tracked.

Dasiglucagon (Zegalogue) is a stabilized glucagon peptide that turns the old mix and inject rescue kit into a single ready to use injection. Across three placebo controlled phase 3 trials in adults and children with type 1 diabetes, it raised blood sugar in a median of about 10 minutes, matching reconstituted glucagon, and its main cost is the nausea and vomiting that come with any glucagon.

The practical advantages are a device that trained caregivers handled more successfully in a simulated emergency and a 12 month room temperature window, while the open questions sit in the newer uses, such as congenital hyperinsulinism and lows after gastric bypass, where the trials are small and approval has not come.