As blogged last week, severe hypoglycemia is a life threatening low blood sugar where the person is not able to treat themselves.  For people with diabetes who take insulin or sulfonylureas, low blood sugars are a potential risk of treatment.


For people who have had a severe low blood sugar in the past, or who are at risk of severe low blood sugars, it is recommended to have glucagon on hand.  Glucagon is a hormone that can rapidly raise low blood sugars and be a lifesaving treatment of severe hypoglycemia.


Traditionally, glucagon has been administered by a needle into the muscle.  Now, a nasal glucagon has become available in Canada, called Baqsimi. It’s super easy to use – simply place the neck of the dispenser into the nose of the person having the severe low blood sugar and depress the plunger.


Nasal glucagon is just as good at raising blood sugars as glucagon injections. What really makes nasal glucagon a big step forward is that it is WAY easier to use. In a study of caregivers of people with diabetes, nasal glucagon was administered successfully 94% of the time, vs only 13% of the time for intramuscular injections. For untrained acquaintances, 93% were able to administer the full dose of nasal glucagon successfully, vs 0% of the time for intramuscular. Also, nasal glucagon was administered in a much shorter time (16-26 seconds) vs intramuscular (2 minutes or more). Seconds count when blood sugars are dangerously low, so this difference in time is meaningful.


In terms of side effects, nausea affects about a third of people who receive either type of glucagon (but remember this is a life saving treatment). More people receiving nasal glucagon get headache and nasal symptoms than with intramuscular glucagon.


In terms of cost, nasal glucagon’s wholesale price in Canada is about $130, vs about $95 for intramuscular glucagon (the price will be higher for both at your pharmacy depending on their markup). Both have a shelf life for about two years.


Bottom Line:  in my view, anyone with diabetes who is on insulin or sulfonylureas should have intranasal glucagon on hand just in case. It could save your life.


Disclaimer:  I receive honoraria as a continuing medical education speaker and consultant from the makers of Baqsimi (Eli Lilly).


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