EXPRESS: Comparing the Efficacy of Transmucosal and Subcutaneous Glucagon Administration in Response to Insulin-Induced Hypoglycemia in Healthy Cats.

Intranasal glucagon effectively and rapidly reverses insulin-induced hypoglycemia in cats with minimal adverse effects.

This randomized crossover study evaluated the efficacy of glucagon administered via three routes—intranasal (IN), rectal, and subcutaneous (SQ)—for reversing insulin-induced hypoglycemia in six healthy cats. Hypoglycemia was induced using a continuous rate infusion of Lispro insulin, achieving a median blood glucose (BG) of 2.6 mmol/L at baseline measurement (T0). Following glucagon administration, BG increased significantly across all routes, with peak median concentrations of 11.2 mmol/L (IN), 9.7 mmol/L (rectal), and 10.15 mmol/L (SQ). Plasma glucagon concentrations rose markedly by 15 minutes post-administration, with the IN route producing substantially higher levels (1562 pmol/L) compared to SQ (191.7 pmol/L) and rectal (158 pmol/L) routes. Insulin-induced hypokalemia was observed, with modest recovery in plasma potassium by 30 minutes post-glucagon across all groups. No serious adverse effects were reported. The IN route demonstrated superior pharmacokinetic and pharmacodynamic profiles, suggesting it may be the preferred non-injectable option for managing hypoglycemic emergencies in cats. The rectal route also showed clinically meaningful efficacy and represents a viable alternative when other routes are unavailable. The study utilized a commercially available single-dose nasal glucagon powder, which is practically accessible to cat owners. Limitations include the small sample size (n=6), use of healthy rather than diabetic cats, and the controlled induction of hypoglycemia. The authors recommend further investigation in diabetic cats experiencing spontaneous hypoglycemic episodes to confirm clinical applicability.

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