Written by Aaron Lacy
In this small study of hypoglycemic patients who received prehospital intranasal glucagon, 32% had substantial improvement, 30% had slight improvement, and 38% had no improvement. There was no clear patient characteristic that predicted response.
Why does this matter?
The number of Americans living with diabetes is substantial and increasing every year, and as a result, 2% of all EMS activations in the United States are related to diabetes. Pairing the need for immediate glucose administration IV or glucagon IM in hypoglycemic patients with the relatively high needle-stick injury rate in prehospital workers, intranasal glucagon for hypoglycemia rescue is an attractive treatment option if effective.
Atomizing glucagon, a good or bad idea?
This retrospective review identified 44 cases of hypoglycemia treated by the Chicago Fire Department with 1mg of intranasal glucagon alone. Overall, the average initial glucose was 30.6 (mg/dl) with an increase to 55.2 post administration. 14 patients had substantial increase in glucose (+53.3, [21.5-85.1]), 13 had slight improvement (+29.9, [2.9-56.9]). 17 patients had no improvement in glucose after administration (+3.1, [-10.1-3.9]).
This study is retrospective, small, and not randomized. The authors report their study showed that IN glucagon resulted in clinically significant improvement in mental status and blood glucose in select settings. However, there was no clear indicator as to what these select settings would be and who would respond, and almost 40% of patients didn’t respond. Because of this, it is hard for me to say we should be trying this primarily. Given the ease of use and new IN formulations of glucagon coming to market, a RCT would help answer this question.
Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care. 2022 Mar 2;1-4. doi: 10.1080/10903127.2022.2045406. Online ahead of print.