Nasal Spray for Diabetes and Low Blood Sugar
Results of a new clinical trial suggest that a new nasal spray could be easier than the only other current treatment for cases of severe low blood sugar (hypoglycemia) in people who have diabetes. It’s uncertain how long it may take for the Food and Drug Administration to approve this diabetes treatment option.
When someone with diabetes experiences severe low blood sugar, time is of the essence—they need glucagon fast. Glucagon is a hormone that is naturally produced by the pancreas, and when administered to a person with severe hypoglycemia, it triggers an immediate rise in blood sugar levels.
Currently, the only FDA-approved glucagon on the market is a powder that must be mixed with water, drawn into a syringe, and injected into the muscle of the affected individual. This process requires that water be readily available, that either the patient or someone else prepare and administered the shot, and if the person with hypoglycemia is unconscious, another person needs to be available to prepare and give the injection.
New nasal spray glucagon for diabetes
The tested nasal spray does not require any preparation. People who experience an episode of hypoglycemia can simply shoot the spray up the nose or if they are unconscious, someone else can do it for them.
The nasal spray was tested in 75 individuals (mean age, 33 years) with type 1 diabetes who were recruited from eight different US clinics. Hypoglycemia was induced twice using intravenous insulin in each volunteer, and they were treated once with an injection and once with the spray.
Here’s what the researchers noted:
- The nasal spray (3 mg) was effective 99 percent of the time
- The injection (1 mg) was effective 100 percent of the time
- It took an average of 16 minutes for the nasal spray to raise blood sugar to an acceptable level
- It took an average of 13 minutes for the injection to reach a suitable blood sugar level
- Side effects included head and/or facial discomfort during 25 percent of nasal spray administrations and 9 percent of intramuscular dosing, while nausea with or without vomiting occurred in 35 percent and 38 percent of visits, respectively
- In an earlier study, researchers had shown that it takes 16 to 26 seconds to administer the nasal spray, yet it can take 1.9 to 2.4 minutes to give the injection
In a WebMD article, two different experts who did not participate in the study expressed their opinions about the fact that it took longer for the nasal spray glucagon to work. Dr. George Grunberger, a clinical professor at Wayne State University School of Medicine, noted that the delay is “probably not clinically significant,” while Dr. Deena Adimoolam, an assistant professor of endocrinology and diabetes with the Icahn School of Medicine at Mount Sinai, in New York City, said “it’s hard to tell whether the delay would be significant.”
For now, the significance of the delay and other information need to be determined by more testing to determine whether this nasal spray product will be safe and practical for people who experience severe hypoglycemia. For example, since people 80 years and older are twice as likely to need emergency room care because of insulin-induced hypoglycemia, the relevance of using the spray in this population needs to be explored.
Rickels MR et al. Intranasal glucagon for treatment of insulin-induced hypoglycemia in adults with type 1 diabetes: a randomized crossover noninferiority study. Diabetes Care 2015 Dec 17; published online before print. DOI:10.2337/dc15-1498
WebMD. Nasal spray may give diabetics faster treatment for low blood sugar