COMMENTARY

Nasal Glucagon a 'Huge Advance' for Caregivers

Anne L. Peters, MD

Disclosures

September 16, 2019

This transcript has been edited for clarity.

Recently, the US Food and Drug Administration approved intranasal glucagon for the treatment of episodes of severe hypoglycemia in patients with diabetes. I consider this a huge advance in terms of the treatment of severe hypoglycemia because it's so much easier to use than those old glucagon kits that we used to prescribe to patients, family members, and friends.

The old glucagon kit required reconstitution and the use of a big, scary needle, which are difficult for caregivers to do, especially when their loved one is on the floor in a coma or having a seizure.

This nasal glucagon is very simple to administer. It comes in an easy-open container and the device itself is very simple. Basically, you put it in the nostril. There's a plunger at the bottom and a switch that is pressed down. It delivers the glucagon intranasally, which is absorbed nearly immediately into the patient's bloodstream.

Within minutes, the patient should begin to respond. Then, over 15 minutes or so, the patient will become more awake, alert, and able to consume carbohydrates and further treat the episode of hypoglycemia.

Be Aware of Side Effects

It's important to realize that glucagon, in any form, still has side effects. Commonly, patients feel nauseated. They may vomit or have a headache, runny nose, or runny eyes. They may not feel well. It's important to be aware of these side effects because the patient will need to consume some carbohydrate. As the patients recover, they should be offered something to drink or eat that they can tolerate so that they don't develop hypoglycemia again.

Nasal glucagon is approved for people as young as 4 years of age, so it fits a wide variety of patients. However, it's one dose of 3 mg. There's no microdosing of this; you can't take a little puff of this here and there to treat a milder hypoglycemia episode. It's all or nothing.

It's a dry powder, which is why it is absorbed so well intranasally and doesn't require reconstitution.

People need to be aware of the side effects after a patient has recovered and make sure that patients are adequately treated to prevent further episodes.

I really consider this an advance. It was used more readily by caregivers in studies comparing intranasal glucagon with injected glucagon.[1] The glucagon was given much more rapidly and the dose was much more likely to be correct.

I'm really looking forward to prescribing this to patients so that their caregivers have an easier way to treat episodes of severe hypoglycemia. Obviously, we'd like to prevent those episodes, but if they happen, they will be less awful for caregivers to deal with—and hopefully, better for patients as well. Thank you.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts and three books on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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