Nasal Glucagon: A Promising New Way to Treat Severe Hypoglycemia

Hypoglycemia is a common side effect of diabetes treatment. Severe hypoglycemia is both potentially dangerous and costly to patients and the health care system. It occurs frequently in patients treated with intensive insulin therapy but can also occur in anyone treated with other hypoglycemic agents. Glucagon is a polypeptide produced by the α-cells in pancreatic islets (1). It stimulates the breakdown of glycogen in the liver with the resultant liberation of glucose, which increases the plasma glucose concentration. Currently, the only available glucagon formulation on the market for the treatment of severe hypoglycemia is injectable glucagon (subcutaneous, intramuscular). However, glucagon is unstable when in solution and so requires reconstitution before administration. This process can be stressful for both patients and caregivers during hypoglycemic emergencies. Nasal glucagon has been shown to be as efficacious as the intramuscular glucagon formulation. Recently, Eli Lilly submitted a new drug application seeking approval of nasal glucagon from the U.S. Food and Drug Administration and the European Medicines Agency. If approved, this agent will be …