Is nasal glucagon a good alternative to injectable glucagon for patients with diabetes that develop hypoglycemia?

This study compared two ways to administer glucagon to stop hypoglycemia (dangerously low blood glucose) in patients with diabetes. The results showed that nasal glucagon (Baqsimi) was as effective as injectable glucagon, with similar side effects.

Patients with type 1 (T1D) and type 2 diabetes (T2D) often take insulin to control blood glucose (sugar) levels. Sometimes blood glucose levels drop too low and this is called hypoglycemia. Hypoglycemia can lead to serious complications if untreated and often patients fall unconscious. 

In a hospital, medical personnel injects a hormone called glucagon to raise blood sugar levels.  However, if a patient develops hypoglycemia at home a caregiver must administer glucagon.  Caregivers often find injections complicated and so there is a need to find an easier way to give patients glucagon. Nasal glucagon sprays are simpler to use. However, it is unclear if nasal glucagon is as effective as injectable glucagon.

Thirty-two patients with T1D and thirty-six patients with T2D were divided into two groups. The first group was given nasal glucagon for the first hypoglycemia experiment and injectable glucagon for the second experiment. The second group received the same drugs in the reverse order. In all cases, patients carried out the experiment after fasting for over 8 hours before being given insulin to cause hypoglycemia. Patients were then given either nasal or injectable glucagon. Blood glucose levels were recorded for 4 hours.

Nasal glucagon was as effective as injectable glucagon in treating hypoglycemia. Hypoglycemia was stopped 12 minutes after nasal glucagon was administered compared to 11 minutes after glucagon was injected. For patients with T1D, nasal glucagon stopped hypoglycemia after 11.6 minutes and injectable glucagon after 10.8 minutes. For patients with T2D, nasal glucagon stopped hypoglycemia after 12.4 minutes and injectable glucagon after 11.3 minutes.

Blood glucose levels continued to rise for 60 minutes after nasal glucagon administration before they started to decrease again. Injectable glucagon caused blood glucose levels to rise for 90 minutes before decreasing.

Overall, 16.9% of patients experienced side effects after nasal glucagon and 12.9% after injectable glucagon. The most common side effects after nasal glucagon were nose pain (8.5% of patients) and nausea (5.6%). The most common side effects after injectable glucagon were nausea (11.4%) and vomiting (4.3%).

The authors concluded that nasal glucagon is as effective as injectable glucagon to treat hypoglycemia and is easier to use.

The manufacturer of nasal glucagon, Eli Lilly, funded this study. This study would benefit by including more patients and examining other drugs that patients are taking. This study did not compare nasal and injectable glucagon in unconscious patients with hypoglycemia. Also, this study was limited by the fact that all patients were Japanese and that there were not many elderly patients included in the study and so may not reflect other patients’ responses.