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Intranasal glucagon comparable to intramuscular for hypoglycemia treatment
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Insulin-induced hypoglycemia was effectively treated with intranasal glucagon in adults with type 1 diabetes, according to recent study findings published in Diabetes Care.
“Although hypoglycemia was induced in a controlled setting by administering insulin, this should approximate the real-world setting of severe hypoglycemia that occurs owing to excessive therapeutic insulin availability relative to the impaired or absent endogenous glucagon response that normally works to limit hypoglycemia,” the researchers wrote.
Michael R. Rickels , MD, MS , associate professor of medicine at the University of Pennsylvania Perelman School of Medicine, and colleagues evaluated 75 adults (mean age, 33 years) with type 1 diabetes to compare the effectiveness of intranasal (3 mg) vs. intramuscular (1 mg) glucagon for treatment of hypoglycemia induced by IV insulin.
Michael R. Rickels
Participants, who underwent two glucagon dosing visits that were 1 to 4 weeks apart, were randomly assigned 3 mg intranasal glucagon or 1 mg intramuscular during the first dosing visit, with the treatments switched at the second dosing visit.
At the intranasal visits, mean plasma glucose was 48 mg/dL compared with 49 mg/dL at the intramuscular visits.
All of the intramuscular visits were successful compared with nearly all (98.7%) of the intranasal visits. Glucagon levels reached pharmacologic levels indicating rapid absorption within 5 minutes of administration of each dose. Time to success was 13 minutes with the intramuscular dose compared with 16 minutes with the intranasal dose. For the first 45 minutes after administration, symptoms of hypoglycemia were greater in the intranasal group but were similar after.
“In the current injectable form, administration of glucagon is a relatively complex process and, outside the home, is often unavailable,” the researchers wrote. “This leads to suboptimal use of an otherwise effective medication, unnecessary delays in treatment, and costly use of emergency medical systems, including ambulance services, emergency room visits and hospital admissions. Based on the results of this study, intranasal glucagon delivery appears promising, and when commercially available, it can be expected to have a substantial beneficial impact on the treatment of severe hypoglycemia.” – by Amber Cox
Disclosure: Foster reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant disclosures.
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