The role of glucagon in the pathophysiology of diabetes has long been recognized though its clinical use is currently limited to emergency hypoglycaemic situations where a large bolus is injected with a glucagon pen. Researchers have, for many years, been developing and testing bi-hormonal artificial pancreas (AP) devices where a controlled mini-bolus of infused insulin and/or glucagon is used to to automatically regulate glucose levels. The addition of a glucagon control loop adds an extra safety mechanism to counteract possible hypoglycaemic events if too much insulin is delivered to the type 1 diabetes subject. This contribution provides an overview of some of the glucagon control strategies, both non-interacting and interacting with the insulin controller, that are currently being considered as part of a bi-hormonal AP device. Approaches used to activate the glucagon control loop, when measured, or predicted, glucose levels drop too low, are also discussed.
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