Nasal versus injected glucagon: User experience results of a simulated severe hypoglycemia study

Objective Injectable glucagon (IG) use is challenging for caregivers of person with diabetes (PWD) in stressful severe hypoglycemia (SH) rescue. Success rates, administration time, user preference for nasal glucagon (NG) vs IG device were evaluated after treating a SH simulation.

Methods Adult PWDs trained caregivers to use NG or IG. Untrained adults, inexperienced with PWDs, were shown one device. 1-week later, both user groups attempted administration to a manikin in a real-life SH simulation. Administration success (complete dose+critical steps) and time (seconds) were studied. Videos of the simulations were viewed and user / PWD perceptions were assessed by comparative questionnaires.

Results 90 % (28/31) and 16 % (5 / 32) of caregivers succeeded with NG and IG. 91 % (30 / 33) of untrained users succeeded with NG, 0 % with IG. Successful NG administration took 30 s for both user groups; 5 IG trained users succeeded in 73 s.

Users, successful with either device, preferred NG; PWDs felt safer with NG, even with successful IG dosing. Successful administrations and user preferences included (N[%]:NG/IG): ease of preparation (PWD-trained: 26[92.9]/4[80.0]; untrained: 24[85.7]/NA); confidence of using correctly (PWD-trained: 22[78.6]/3[60.0]; untrained: 27[96.4]/NA); easy-to-use (PWD-trained: 23[82.1]/4[80.0]; untrained: 27[96.4]/NA); satisfaction (PWD-trained: 22[78.6]/3[60.0]; untrained: 24[85.7]/NA); preference (PWD-trained: 24[85.7]/4[80.0]; untrained: 26[92.9]/NA). Untrained and PWD-trained users were equally successful dosing NG. IG succeeded only with training.

Conclusions Users were more successful and faster administering NG vs IG. None who preferred IG were successful with IG, while few successful IG users preferred NG or stated no preference. NG success was independent of training; ease of preparation / use likely contributes to overall preference.

Publication History

Article published online:
06 May 2021