Glucagon: evidence, FDA status and research

An emergency treatment for dangerously low blood sugar, as a kit, a pen or a nose powder. Trials show the newer forms work as well as the kit.

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Glucagon is the emergency treatment for severe low blood sugar in people who use insulin, now available as a nasal powder and an autoinjector as well as the older mix-it-yourself kit.

Studies say

Randomised trials show that nasal and ready-to-use glucagon raise blood glucose as reliably as the injected kit within minutes, supporting the approvals and the A grade.

Why grade A. Glucagon's approval for severe hypoglycemia rests on decades of clinical use plus randomised trials of the newer formulations. The cited trial, 75 adults with type 1 diabetes in a randomised crossover design, showed nasal glucagon reversed insulin-induced hypoglycemia at 98.7% of visits against 100% for intramuscular glucagon. ²³⁴

FDA. Glucagon is FDA-approved for severe hypoglycemia and as a diagnostic aid to relax the gut during imaging. Current products include glucagon for injection kits, Gvoke (ready-to-use injection, approved 2019) and Baqsimi (nasal powder, approved 2019); Novo Nordisk discontinued GlucaGen HypoKit in the US on July 1, 2024. ³⁴⁵¹

Written from 5 cited sources. Fact-checked 2026-10-27: 16 claims checked, 3 corrected. Last refreshed 2026-10-27. Not physician reviewed.

What this means for you

What people take it for: Treating very low blood sugar; also helps with gut scans.
Can a US doctor prescribe it?: Yes, FDA approved for very low blood sugar, and as an aid in gut scans.
Properly tested in people?: Yes, in large controlled trials: for example, 75 adults in a nose powder trial; 98.7% recovered.

Evidence checklist

Randomised controlled trial Randomized crossover of nasal vs injectedyes
Human study over 100 people Cited trial had 75 adultsno
More than one research group Several formulations and sponsors studiedyes
Clinical outcomes, not surrogate markers Glucose recovery in induced hypoglycemiano
Human safety data beyond case reports Trial and label safety datayes

Drawn from the cited studies below. A dash means the sources give no information.

What it is

Glucagon is a 29-amino-acid hormone made by the alpha cells of the pancreas. It is insulin's opposite: when blood sugar falls, glucagon tells the liver to break down stored glycogen and release glucose. Pharmaceutical glucagon is identical to the human hormone; GlucaGen is made by recombinant DNA in yeast, while Gvoke is made by chemical synthesis. ³⁴⁵

For most of its history glucagon came as a powder that had to be mixed with diluent and injected during an emergency, a procedure bystanders often got wrong. The 2019 approvals of Baqsimi, a dry nasal powder, and Gvoke, a pre-mixed autoinjector or syringe, removed the mixing step. ³⁴

How it works

Glucagon binds its receptor on liver cells and triggers glycogenolysis, the breakdown of stored glycogen into glucose, and gluconeogenesis, the production of new glucose. Blood sugar begins to rise within about 10 to 15 minutes. Because it depends on liver glycogen stores, glucagon works less well in starvation, adrenal insufficiency or chronic hypoglycemia. It also inhibits gut motility, which is the basis of its use as a diagnostic aid during radiology. ³⁴⁵

What human research shows

Rickels and colleagues ran a randomised crossover trial at eight centres in 75 adults with type 1 diabetes. Hypoglycemia was induced with intravenous insulin and then treated with either nasal glucagon or the intramuscular kit. Success, defined as glucose climbing back to the normal range or by 20 points from the low within 30 minutes, occurred at 98.7% of nasal visits and 100% of injection visits; mean time to success was 16 minutes nasal versus 13 minutes injected. ²

Gvoke's approval rested on comparable studies showing that the ready-to-use liquid formulation raised glucose as effectively as the reconstituted kit in adults and children with diabetes. ³

Study	Model	Finding
Rickels 2016, nasal versus intramuscular	Humans, n=75 adults with type 1 diabetes, randomised crossover noninferiority	Nasal glucagon reversed insulin-induced hypoglycemia at 98.7% of visits versus 100% for intramuscular, with a 3-minute slower mean time to success. ²
Baqsimi label, 2019	FDA prescribing information	Approved for severe hypoglycemia in patients with diabetes aged 4 and older as a single-use nasal powder. ⁴
Gvoke label, 2019	FDA prescribing information	Approved as a ready-to-use subcutaneous injection for severe hypoglycemia in patients with diabetes aged 2 and older. ³

Safety

Nausea and vomiting are the most common effects, reported at roughly a third of visits with either route in the crossover trial, and headache or nasal discomfort is more frequent with the nasal powder. Glucagon is contraindicated in pheochromocytoma, a tumour that can release catecholamines in response to it, and in insulinoma. It can fail when liver glycogen is depleted, so follow-up carbohydrate once the person can swallow is standard labelling. ²³⁴

Questions for your clinician

Which glucagon form suits me, and who should know how to give it?
Do I have a tumour or condition that rules it out?
What should I eat after a dose?

Questions people ask

Is glucagon FDA-approved?

Yes. Glucagon for injection has been approved for decades for severe hypoglycemia and as a diagnostic aid. Baqsimi (nasal) and Gvoke (ready-to-use injection) were both approved in 2019. ³⁴⁵

What happened to GlucaGen HypoKit?

Novo Nordisk permanently discontinued it in the US on July 1, 2024, citing a global shortfall of pre-filled syringes from its supplier. Other glucagon kits, Gvoke and Baqsimi remain available. ¹

Does nasal glucagon work as well as the injection?

In a 75-person randomised crossover trial it worked at 98.7% of hypoglycemia episodes compared with 100% for the injection, and took about three minutes longer on average. The trial was designed to show noninferiority and did. ²

Why does glucagon sometimes fail?

It works by releasing glucose stored as glycogen in the liver. In starvation, adrenal insufficiency or chronic hypoglycemia those stores can be low, so there is little for glucagon to release. ³⁴

Citations

Novo Nordisk: GlucaGen HypoKit US discontinuation notice novomedlink.com
Rickels 2016, Diabetes Care: intranasal glucagon for insulin-induced hypoglycemia in adults with type 1 diabetes doi.org
FDA 2019: Gvoke (glucagon injection) prescribing information accessdata.fda.gov
FDA 2019: Baqsimi (glucagon nasal powder) prescribing information accessdata.fda.gov
Novo Nordisk 2021: GlucaGen (glucagon) HypoKit and Diagnostic Kit prescribing information novo-pi.com