How a nasal spray simplifies the treatment of potentially deadly low blood sugar crisis

It is important for Canadians at risk of severe hypoglycemia to stay prepared for a severe low blood sugar emergency.

The first time Mark Hanlon experienced hypoglycemia, it was an important wakeup call. It happened during a workday at the office. “I began sweating profusely and wasn’t feeling alert at all. Fortunately, I managed to get it under control, but I immediately thought, what can I do to be prepared if it happens again?” He has since had other minor low blood sugar episodes in situations where he has not eaten properly or pushed himself too far while exercising.

“When it starts to happen, it’s almost like a snowball going down a hill… You have to find a way to stop the progression.”

Hanlon carries a supply of glucose tablets and keeps a juice box with him at all times, but a more recent and essential addition to his arsenal is a dry nasal spray called Baqsimi. Developed for extremely low blood sugar (severe hypoglycemia), it is a Canadian invented treatment, which can be absorbed through the nose and is available with and without a prescription.

The treatment contains glucagon, a naturally occurring hormone that helps to stabilize glucose levels and has been used for years in treating severe hypoglycemia. Among its key benefits: it can be given to an unconscious patient by trained or untrained caregivers.

The risks surrounding severe hypoglycemia are significant and can cause loss of consciousness, coma, or even death. Baqsimi is an option used to treat severe hypoglycemia for adults and children four years and older that take insulin.

For years the treatment approach has required a complicated injection. “The problem is it’s an awkward system,” says Dr. Stuart Ross, endocrinologist, clinical professor of medicine at the University of Calgary. “You have to reconstitute the liquid and powder, draw the solution into the syringe and inject it. That might be okay when you’re at home. But it’s not when you’re out.”

This can get complicated depending on the severity of the episode. “You have to still be conscious or someone has to know how to do it. The problem is, in cases of severe hypoglycemia you can’t do anything for yourself.”

THEY APPRECIATE THE FACT THEY CAN GO TO SLEEP KNOWING THERE IS IMMEDIATE HELP. IT'S BEEN A GREAT ADDITION TO OUR SYSTEM

When talking to his patients, Dr. Ross said the number one concern is that they could lose control during a low blood sugar episode and not be able to wake up. “When blood sugar drops beyond normal, you can lose all your ability to coordinate. You may not be able to walk, your vision can be blurred, you may not be able to swallow – it’s terrible for people to have to live with that fear.”

The pandemic has exacerbated that fear, due to potential for higher risk of complications from the COVID-19 infection. “The last thing they want to do is go to a hospital or clinic where they could be exposed,” he says.

Adding to the stress is that the most successful way to work with patients is through a team approach that includes healthcare providers, patients, and family members. “The team approach requires maximum contact, so the worry is higher for patients these days.”

Dr. Ross says the nasal glucagon option is a significant breakthrough in alleviating some of the concerns. “A friend or family member with no experience can easily do it. It’s much like sinus flasks people use to clear congestion. When I talk to patients about it the first thing they say is how soon can I get this? I recommend it to all patients at risk.”

As a single parent of an 11and 14-year-old, Hanlon says the spray option has brought considerable peace of mind, especially now that that he is working from home. “At the office, my co-workers were part of my safety net. It’s a little different now working from home, and more important than ever that my kids know how to rescue me. If they can’t wake me up, they can simply open the device from the yellow tube package, insert the device tip in my nose and press a button. An injection would be impossible for them to do.”

Another benefit is peace of mind, Dr. Ross says. “They appreciate the fact they can go to sleep knowing there is immediate help. It’s been a great addition to our system.”

Hanlon would agree. “Anyone can use it. I’ve even instructed my neighbour on what to do. While I always have one in the house and another in my pocket, my hope is I never have to use it. But the fact I’ve been close to losing consciousness several times, it’s reassuring to know it’s available.”