nasal spray treatment

A nasal spray could provide a more convenient alternative to glucagon injections to treat severe hypoglycemia, according to new research.

The nasal spray, although slightly less effective, is easier to use than glucagon injections, which are currently the only treatment for severe hypoglycemia.

“This nasal spray is a big deal”

“This intranasal spray is a big deal,” said Dr. George Grunberger, a clinical professor at Wayne State University School of Medicine in Detroit and president of the American Association of Clinical Endocrinologists. Grunberger was not involved in the study. “This is something which people have been crying out for, for years. It was only a matter of time before something more practical came onto the market.”

Severe hypoglycemia is defined as any episode of hypoglycemia that requires help from another person to treat. It is characterised by dizziness, vomiting and even unconsciousness. In some cases, the person having the hypo can recover enough to treat it themselves – by drinking a sugary drink or taking a glucose tablet – but glucagon injections are often necessary.

However, glucagon injections are inconvenient. They require training and experience to properly administer.

“Somebody has to have the vial of glucagon to hand, then they have to add water, shake it up and inject it into muscle,” Grunberger said. “This is a problem, because by definition the ones who need it are the ones who can’t inject it because they’re unconscious.”

How was the study conducted?

The research was conducted using the data of 75 adults, all of whom had type 1 diabetes. Each participant experienced two episodes of hypoglycemia. One episode was treated with glucagon injection; the other with nasal spray.

Glucagon injections worked every time, whereas the nasal spray was 99 per cent effective. Glucagon injections are also quicker-acting – 16 minutes compared to 13 minutes for the nasal spray. However, preparing the glucagon injection can add a lot of time to the process. A previous study found that administering the nasal spray took between 16 and 26 seconds, whereas the injection took a total of 1.9 to 2.4 minutes, depending on experience and training.

“It took a bit longer for intranasal glucagon to work, but given the situation it’s probably not clinically significant,” said Grunberger.

However, Dr. Denna Adimoolam, assistant professor of endocrinology and diabetes at the Icahn School of Medicine at Mount Sinai, New York, expressed concerns about the delay in the spray function.

“We don’t really know if clinically that delay matters,” said Adimoolam. “In that time, you can have a seizure. You can lose consciousness. There could be catastrophic events. So it’s hard to tell whether the delay would be significant.”

Side effects and limitations

Adimoolam argues that the study’s narrow age group means it is not as comprehensive as it could be.

“I think it would have been even more interesting if this study looked at how this medication could help the elderly who are at even higher risk for insulin-related hypoglycemia than the age group evaluated in the study,” she said.

The nasal spray has several side effects, including head and facial discomfort and, in a third of the participants, nausea.

Eli Lilly owns the right to the nasal spray and plans to bring it to market. There are as yet no indications as to when the spray will be available.

The findings are published in Diabetes Care.