Summary
The aim of the present study was to compare intranasal glucagon with subcutaneous glucagon as a treatment of insulin-induced hypoglycaemia in 11 children, 7–12 years old, with Type 1 (insulin-dependent) diabetes mellitus. Hypoglycaemia (1.6±0.1 vs 1.8±0.2 mmol/l) was induced twice in each child by continuous insulin and variable glucose infusions. One milligram of intranasal glucagon or 0.5 mg of subcutaneous glucagon was given in a randomized order. At 15 min after the administrations of either intranasal or subcutaneous glucagon, the blood glucose concentration increased by 1.5±0.2 mmol/l or 1.7±0.2 mmol/l above the glucose nadir, respectively. After nasal administration, the maximal rise in blood glucose was seen after 25 min. Subcutaneous injections induced higher and more sustained plasma glucagon concentrations but the children suffered more often from nausea than when they were treated intranasally. In conclusion, treatment with intranasal glucagon seems to be efficient and results in a rapid correction of insulin-induced hypoglycaemia with few side-effects.
Similar content being viewed by others
References
Egger M, Gschwend S, Smith GD, Zuppinger K (1991) Increasing incidence of hypoglycemic coma in children with IDDM. Diabetes Care 14: 1001–1005
Åman J, Karlsson I, Wranne L (1989) Symptomatic hypoglycaemia in childhood diabetes: a population-based questionnaire study. Diabetic Med 6: 257–261
The DCCT research group (1987) Diabetes control and complications trial (DCCT): results of feasibility study. Diabetes Care 10: 1–19
Reichard P, Berglund A, Britz A, Levander S, Rosenqvist U (1991) Hypoglycaemia episodes during intensified insulin treatment: increased frequency but no effect on cognitive function. J Intern Med 229: 9–16
Ryan C, Vega A, Drash A (1985) Cognitive deficits in adolescents who developed diabetes early in life. Pediatrics 75: 921–927
Rovet JF, Ehrlich RM, Hoppe M (1987) Intellectual deficits associated with early onset of insulin-dependent diabetes in children. Diabetes Care 10: 510–515
Golden M, Ingersoll G, Brack C, Russell C, Wright J, Huberty T (1989) Longitudinal relationship of asymptomatic hypoglycemia to cognitive function in IDDM. Diabetes Care 12: 89–93
Langan SJ, Deary IJ, Hepburn DA, Frier BM (1991) Cumulative cognitive impairment following recurrent severe hypoglycaemia in adult patients with insulin-treated diabetes mellitus. Diabetologia 34: 337–344
Wredling R, Levander S, Adamson U, Lins PE (1990) Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man. Diabetologia 33: 152–157
Mühlhauser I, Berger M, Sonnenberg G, Koch J, Jörgens V (1985) Incidence and management of severe hypoglycaemia in 434 adults with insulin-dependent diabetes mellitus. Diabetes Care 8: 268–273
Åman J, Wranne L (1988) Hypoglycaemia in childhood diabetes. Effect of subcutaneous or intramuscular injection of different doses of glucagon. Acta Paediatr Scand 77: 548–553
Pontiroli A, Alberetto M, Pozza G (1984) Metabolic effects of intranasally administered glucagon: comparison with intramuscular and inravenous injecton. Acta Diabetol Lat 22: 103–110
Slama G, Alamowitch C, Desplanque N, Letanoux M, Zirinis P (1990) A new non-invasive method for treating insulin-reaction: intranasal lyophylized glucagon. Diabetologia 33: 671–674
Slama G, Reach G, Cahane M, Quetin C, Villanove-Robin F (1992) Intranasal glucagon in the treatment of hypoglycaemic attacks in children: experience at a summer camp. Diabetologia 35: 398 (Letter)
Jørgensen S, Sørensen AR, Kimer LL, Mygind N (1991) A new non-invasive method for treating insulin-reaction: intranasal lyophylized glucagon. Diabetes 40: A2190 (Abstract)
Faloona G, Unger R (1974) Glucagon. In: Jaffe B, Behrman H (eds) Methods of hormone radioimmunoassay. Academic Press, New York, pp 317–330
Poulsen F, Jørgensen PN, Bucher D (1987) A two-site enzyme immunoassay (EIA) using biotin-labelled antibody and avidinperoxidase conjugate for human insulin in serum. Ann Clin Biochem [Suppl 2]: 246–247
Jeppsson JO, Jerntorp P, Sundkvist G, Englund H, Nylund V (1986) Measurement of HbA1c by a new lipuid-chromatographic assay: methodology, clinical utility and relation to glucose tolerance evaluated. Clin Chem 32: 1867–1872
Gunning RR, Garber AJ (1978) Bioactivity of instant glucosefailure of absorption through oral mucosa. JAMA 240: 1611–1612
Åman J, Wranne L (1984) Treatment of hypoglycaemia in diabetes: failure of absorption of glucose through rectal mucosa. Acta Paediatr Scand 73: 560–561
Daneman D, Frank M, Perlman K, Tamm J, Erlich R (1989) Severe hypoglycemia in children with insulin-dependent diabetes mellitus: frequency and predisposing factors. J Pediatr 115: 681–685
Rosenfalck AM, Bendtson I, Jørgensen S, Binder C (1992) Nasal glucagon in the treatment of hypoglycaemia in type 1 (insulin-dependent) diabetic patients. Diab Res Clin Pract 17: 43–50
Onyang A, Cohen S (1981) Effects of hormones on gastro-intestinal motility. Med Clin North Am 217: 1111–1127
Aylet P (1962) Gastric emptying and change of blood glucose level, as effected by glucagon and insulin. Clin Sci 22: 171–178
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stenninger, E., Åman, J. Intranasal glucagon treatment relieves hypoglycaemia in children with Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 36, 931–935 (1993). https://doi.org/10.1007/BF02374475
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02374475