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Nasal Glucagon Approved to Treat Severe Hypoglycemia

If you or someone you love is living with type 1 diabetes, you know that, in addition to blood sugar becoming too high, having it drop too low is a serious concern as well. When blood sugar falls below 70mg/dL, individuals often start feeling the effects such as shakiness, sweating, chills, lightheadedness, weakness, blurry vision, or tiredness.

If blood sugar continues to drop, it can lead to severe hypoglycemia where the person may be unable to treat their low blood sugar themselves due to confusion, seizures, or loss of consciousness. When this occurs, the individual with T1D often relies on medical personnel or a trained bystander to administer glucagon. Traditionally, glucagon is injected into the arm, thigh, or buttock. However, the medication must first be reconstituted, which involves injecting the contents of the syringe into a vial, mixing it together, then drawing it back into the syringe to inject into the person. In an emergency situation, this can be a lot of steps to follow and there is plenty of room for error.

In an effort to simplify the process, Eli Lilly and Company has manufactured the first ever FDA-approved nasal glucagon, Baqsimi. The device is pre-loaded with 3 mg of glucagon and ready to use for patients age 4 and older. The medication stimulates the liver to release glucose and was found to effectively reverse insulin-induced hypoglycemia based on three studies encompassing more than 200 participants. There were no major safety concerns, and the potential adverse reactions were similar to those of injectable glucagon with the addition of watery eyes and nasal congestion. However, nasal glucagon is not recommended for individuals with pheochromocytoma or insulinoma.

Nasal glucagon provides yet another option for individuals with T1D to quickly – and more easily – treat episodes of severe hypoglycemia. It is simple to use because there is no reconstitution, multi-step processes, or injections necessary. The drug is expected to hit the U.S. market around the beginning of September 2019.

We are excited to see this new product come to market and is interested to see how it impacts diabetes care and management for individuals who experience severe hypoglycemia.

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Nasal Glucagon May Become New Option for Treating Hypoglycemia

When blood sugar drops and hypoglycemia occurs, it is critical for individuals with type 1 diabetes to receive immediate treatment to raise their blood sugar. If left untreated, it can lead to severe confusion, seizures, or even loss of consciousness. One of the main ways of treating hypoglycemia is administering glucagon.

Glucagon is a hormone that stimulates the body to convert glycogen into glucose. It also keeps the liver from consuming too much glucose so that it can be circulated in the bloodstream instead. Traditionally, glucagon is delivered through an intramuscular injection. A solution is mixed to dissolve the glucagon, then it is administered by syringe.

However, many caregivers – or even bystanders – may be hesitant to give someone else a shot of glucagon. Preparing the syringe and shot is a multistep process and can be confusing if the person is not properly trained. Plus, they are under considerable stress in emergency situations where it must be given, which can complicate things even further.

A new study has found that nasal glucagon may be just as effective as intramuscular glucagon in raising blood sugar levels during episodes of hypoglycemia. There is no preparation necessary before administering the medication. It is a powder that comes in a single-use device that is sprayed up the nose. It isn’t even necessary for the patient to inhale because the powder is absorbed on its own.

Both treatment methods were tested on 70 adult participants with type 1 diabetes. A state of hypoglycemia was induced, and then they were treated with either the intramuscular or nasal glucagon. One to seven days later, the process was repeated, and the other form of medication was administered. In 100 percent of cases, hypoglycemia was reversed and participants had no serious adverse events. In 97 percent of cases, treatment success was achieved within 15 minutes.

This new treatment option was presented at the European Association for the Study of Diabetes (EASD) by Leona Plum-Moerschel, MD, of Profil Mainz, Germany. According to Plum-Moerschel, “I think we can all agree that the safety profile is very much acceptable for an emergency treatment. I personally would expect that, due to its simplicity of use, nasal glucagon will create a greater community who can render quick aid in a rescue situation.”

The Diabetes Research Connection (DRC) is interested to see if this nasal formulation will be brought to market and how it will affect the treatment of hypoglycemia in children and adults. It is encouraging to see treatment options becoming more user-friendly so that even non-medical personnel can effectively administer emergency medications.

The DRC supports research geared toward the treatment and prevention of type 1 diabetes, as well as improvement of quality of life for those living with the disease. Access to funding is essential for scientists to continue advancing their research, and the DRC provides these types of resources. To learn more about current projects and donate to support these efforts, visit http://diabetesresearchconnection.org.

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