Transmucosal glucagon rapidly increases blood glucose concentration in healthy cats

To evaluate the effect of transmucosal glucagon powder (Baqsimi; Amphastar Pharmaceuticals) on blood glucose (BG) concentrations in healthy cats and describe adverse reactions to its administration.

A randomized, controlled, crossover study was conducted on six healthy cats with a 7-day washout period between treatments. Transmucosal glucagon powder was administered intranasally and rectally and compared with intranasal placebo. Blood was collected at -15 and -1 mins before glucagon administration and 5, 15, 25, 35, 45 and 60 mins after to evaluate BG, plasma glucagon concentrations (pGlucagon) and plasma potassium concentrations (K⁺). Stress scores and adverse effects were recorded at all time points.

Median pGlucagon in the nasal and rectal groups increased from baseline (nasal: 12.2 pmol/l, range 3.5-44.1; rectal: 6.9 pmol/l, range 2.9-21.1) to 218.5 pmol/l (range 7.9-349.8; P = 0.02) and 349.8 pmol/l (range 67.4-349.8; P = 0.01), respectively, 15 mins after administration. Median BG increased from baseline (101 mg/dl, range 91-110) 15 mins after nasal (137.5 mg/dl, range 104-251; P = 0.006) and rectal (229 mg/dl, range 99-285; P = 0.002) administration. Median K+ decreased from baseline (nasal: 3.8 mmol/l, range 3.6-4.1; rectal: 3.7 mmol/l, range 3.5-3.9) to 3.4 mmol/l (range 3.1-3.6; P = 0.04) at 15 mins with nasal administration, and to 3.2 mmol/l (range 3.1-3.6; P = 0.04) at 15 mins and 3.1 mmol/l (range 2.9-3.4; P = 0.01) at 25 mins with rectal administration. No significant changes were detected in the placebo group. No serious adverse effects were noted.

Transmucosal glucagon administration is effective in raising BG with minimal side effects in healthy cats. Future studies are needed to quantify the efficacy and safety of transmucosal glucagon in diabetic cats, especially during hypoglycemic crises.