Could Intranasal Glucagon Effectively Treat Hypoglycemia?

Intranasal glucagon is highly effective in treating hypoglycemia in adults with type 1 diabetes, and, because of its ease of use, could be a good alternative to injected intramuscular glucagon, according to a recent study.

“Treatment of severe hypoglycemia with loss of consciousness or seizure outside of the hospital setting is presently limited to intramuscular glucagon requiring reconstitution immediately prior to injection, a process prone to error or omission,” researchers explained.
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To test a needle-free intranasal glucagon option, researchers conducted a randomized crossover noninferiority trial at 8 clinical centers involving 75 adults with type 1 diabetes (mean age 33), comparing 3 mg of intranasal glucagon against 1 mg of intramuscular glucagon for the treatment of hypoglycemia induced by intravenous insulin.

Mean plasma glucose at the time of administration of glucagon was 48 ± 8 and 49 ± 8 mg/dL at the intranasal and intramuscular visits, respectively. Success was defined as an increase in plasma glucose to 70mg/dL or higher or an increase of 20mg/dL or more from the lowest point at 30 minutes after receiving glucagon.

Overall, criteria for success was met in 100% of intramuscular and 98.7% of intranasal instances, with a mean time to success of 16 minutes for intranasal and 13 minutes for intramuscular. Head discomfort was reported in 25% of intranasal and 9% of intramuscular visits, while nausea occurred in 35% and 28% of visits, respectively.

“Intranasal glucagon was highly effective in treating insulin-induced hypoglycemia in adults with type 1 diabetes. Although the trial was conducted in a controlled setting, the results are applicable to real-world management of severe hypoglycemia, which occurs owing to excessive therapeutic insulin relative to the impaired or absent endogenous glucagon response.”

—Michael Potts

Reference:
Rickels MR, Ruedy KJ, Foster NC, et al. Intranasal glucagon for treatment of insulin-induced hypoglycemia in adults with type 1 diabetes: a randomized crossover noninferiority study. Diabetes Care. December 17, 2015 [epub ahead of print]. doi: 10.2337/dc15-1498.