In the Literature
Cohen EA, Porter L, Crews CD, Mott J, Tardo AM, Gilor C. Transmucosal glucagon rapidly increases blood glucose concentration in healthy cats. J Feline Med Surg. 2024;26(11):1098612X241280516. doi:10.1177/1098612X241280516
The Research …
Hypoglycemia is a serious potential complication in diabetic cats receiving insulin therapy. Typical treatment for hypoglycemia includes hospitalization with dextrose IV boluses or CRIs. Multiple days of hospitalization may be required depending on the cause of hypoglycemia and type of insulin used.1
In humans, injectable glucagon is used to treat severe hypoglycemia. Glucagon is a counterregulatory hormone to insulin that aids in glycemic control by stimulating breakdown of glycogen in the liver to increase blood sugar.2 Glucagon powder that can be administered in emergency situations using a one-step dispensing device is approved for intranasal use in humans.3
This randomized, controlled crossover studya evaluated glucagon powder as a potential treatment for hypoglycemia in cats and described adverse effects. Healthy, purpose-bred cats (n = 6) were given glucagon powder intranasally and rectally and received an intranasal placebo with a 7-day washout period between each administration. In cats that responded to intranasal administration (3/6), blood glucose increased by >20 mg/dL within 5 minutes. Cats that responded to rectal administration (4/5) had a similar increase in blood glucose within 15 minutes. No blood glucose changes were noted with the placebo. Of note, 2 of the 3 cats that did not have an increase in blood glucose following intranasal administration had incomplete or failed powder administration.
Following intranasal administration, sneezing within seconds of administration (4/6) was the most common adverse effect, followed by hypersalivation (3/6) and blepharospasm (2/6). Following rectal administration, vomiting (2/5) was the most common adverse effect, with 1 cat vomiting 11 minutes after administration and 1 cat vomiting 60 minutes after administration. Decreased potassium has been noted in humans receiving glucagon,3 but this study did not reveal clinically significant changes in potassium levels.
a The authors of this study were partially supported by Merck Animal Health.
… The Takeaways
Key pearls to put into practice:
In this study, transmucosal glucagon raised blood glucose in healthy cats regardless of administration method; however, rectal administration resulted in a larger increase than intranasal administration, and not all cats responded to treatment. Future studies in diabetic cats are needed to evaluate the efficacy and safety of transmucosal glucagon.
The most common adverse effects were sneezing following intranasal administration and vomiting following rectal administration. Whether sneezing influences the effect of the medication on blood glucose is unclear. In humans, nausea and vomiting are the most common adverse effects.3 Vomiting is an important consideration in obtunded patients.
Although changes in potassium are a possible adverse effect noted in humans, only mild changes occurred in this study. Of note, this study had a small sample size and may underestimate changes in potassium.
The cost of glucagon powder may be a consideration; however, this product only needs to be purchased once because of its long shelf-life and may prevent hospitalization.
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