Intranasal glucagon for hypoglycaemia in diabetic patients. An old dream is becoming reality?

Diabetes Obes Metab. 2018 Aug;20(8):1812-1816. doi: 10.1111/dom.13317. Epub 2018 May 2.


In 1983 it was shown that glucagon administered intranasally (IN) was absorbed through the nasal mucosa and increased blood glucose in healthy subjects. Shortly thereafter, it was shown that IN glucagon counteracts with hypoglycaemia in insulin-treated diabetic patients. In spite of this evidence, IN glucagon was not developed by any pharmaceutical company before 2010, when renewed interest led to intensive evaluation of a possible remedy for hypoglycaemia in insulin-treated diabetic adults and children. IN glucagon is now being developed as a needle-free device that delivers glucagon powder for treatment of severe hypoglycaemia; the ease of using this device stands in stark contrast to the difficulties encountered in use of the current intramuscular glucagon emergency kits. Studies have demonstrated the efficacy, safety and ease-of-use of this IN glucagon preparation, and suggest IN glucagon as a promising alternative to injectable glucagon for treating severe hypoglycaemia in children and adults who use insulin. This would meet the unmet medical need for an easily administered glucagon preparation.

Keywords: common cold; diabetes mellitus; emergency; glucagon; glucose; hypoglycaemia; insulin; intramuscular; intranasal; intravenous; nasal; powders; real world; severe hypoglycemia; type 1 diabetes; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adjuvants, Pharmaceutic / chemistry
  • Administration, Intranasal
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Drug Compounding
  • Emergency Treatment* / adverse effects
  • Glucagon / administration & dosage*
  • Glucagon / adverse effects
  • Glucagon / chemistry
  • Glucagon / therapeutic use
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / drug therapy*
  • Hypoglycemia / physiopathology
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • Insulin / adverse effects*
  • Insulin / therapeutic use
  • Phosphorylcholine / analogs & derivatives
  • Phosphorylcholine / chemistry
  • Powders
  • Severity of Illness Index
  • beta-Cyclodextrins / chemistry


  • Adjuvants, Pharmaceutic
  • Hypoglycemic Agents
  • Insulin
  • Powders
  • beta-Cyclodextrins
  • Phosphorylcholine
  • dodecylphosphocholine
  • Glucagon
  • betadex