A comparison of glucagon and glucose in prehospital hypoglycaemia.

Glucagon Underutilized Among Type 1 Diabetes Mellitus Patients in Japan

“…There are reports describing the efficacy and safety of glucagon administered by healthcare providers; however, those by non-medical bystanders are not well documented. [7][8][9][10][11] Thus, efforts to prevent severe hypoglycemia itself remain primarily important.…”

Glucagon for hypoglycemic episodes in insulin-treated diabetic patients: a systematic review and meta-analysis with a comparison of glucagon with dextrose and of different glucagon formulations

“…For the same reason, a superiority of dextrose over glucagon would be expected in treating patients with severe insulin-induced hypoglycemia, as reported by some authors [58][59][60], suggesting that glucagon may be preferable in non-critical subjects and Duplicates or Reviews n = 0 not dealing with glucagon * n = 314…”

“…3 Meta-analysis of efficacy of glucagon compared to dextrose in the treatment of hypoglycemia. This meta-analysis was a simulation; one study was intentionally discarded because of inconsistency with the remaining studies when an IV line is unavailable; nevertheless as suggested by some authors, since glucagon requires endogenous glucose, it is likely to produce a more predictable rise of blood glucose levels than when large amount of IV glucose is used, avoiding hyperglycemic rebounds [58]. Moreover, in several cases, multiple glucagon injections have been reported to be effective in managing hypoglycemic patients in a pre-hospital setting; for instance, Haymond et al [38] showed an increase of blood glucose in 14 children nonresponsive to a first administration of glucagon, after a second or a third injection.…”

“…Measure of efficacy was the number/percentage of patients/subjects not responding to glucagon according to criteria pre-defined by the authors of each paper. All the data are tabulated in Tables 1 and 2. Sixteen studies fulfilled the inclusion criteria [33,42,44,[50][51][52][53][54][55][56][57][58][59][60][61][62]. Details of data source and searches, study selection, data extraction and quality assessment, data synthesis, ER emergency room, SH severe hypoglycemia, IV intravenous, IM intramuscular; AEs adverse events, FDA food and drugs administration, EMS emergency medical services, and NEMSIS national emergency medical services information system and analysis have already been published [12].…”

“…Again, data from the National EMS Information System (NEMSIS) regarding the pre-hospital EMS response to diabetic emergencies in the United States indicated that, in 2011, glucagon was administered 18,483 times in runs listed in the dataset, with 436 times requiring a repeat dose [54]; the Food and Drug Administration (FDA), and Health Canada, reported 82 and 8 failures out of a total of 568 reports from 2011 to 2012 and of 20 reports from 1997 to 2012, respectively [55,56]. Some authors, comparing IM glucagon to IV dextrose in the pre-hospital settings, showed a delay in recovering from an hypoglycemic event with glucagon [57][58][59][60], but with a steady increase in blood glucose [58]; in contrast, dextrose treated patients seemed to have more fluctuations of blood glucose.…”