Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department.

Abstract

SUMMARYHypoglycaemia remains a serious and much feared complication of insulin therapy. In this study, patients attending an accident and emergency department in hypoglycaemic coma were randomized to treatment with either intravenous dextrose (25g) or intramuscular glucagon (lmg), administered into the right thigh. Restoration of normal conscious level was slower after glucagon than dextrose (90 vs 30 min, P<0-01), although the average duration of hypoglycaemic coma was 120 min. Two patients in the glucagon-treated group, who failed to show satisfactory recovery after 15 min, required additional treatment with intravenous dextrose. On questioning following recovery, all except two patients reported loss of awareness of the onset of hypoglycaemia.Intramuscular glucagon is valuable in the treatment of severe hypoglycaemia outwith hospital and, although the slightly slower and less predictable recovery may appear to make it a less attractive option than intravenous dextrose in the accident and emergency department, this must be balanced against the advantages of ease of administration and a lower incidence of serious adverse effects.

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…”

“…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.…”

Counterregulatory hormones in insulin-treated diabetic patients admitted to an accident and emergency department with hypoglycaemia

“…The frequency of recurrent hypoglycaemia after treatment of an index episode of hypoglycaemia has been reported to range between 2 and 30 %. [15][16][17][18][19][20] In the present study we have also compared two treatments of accidental insulin-induced hypoglycaemia: intravenous glucose alone and intravenous glucose supplemented by intramuscular glucagon; [21][22][23] with the hypothesis that a combined treatment might better achieve both a rapid and long lasting hyperglycaemic effect, with greater chance of avoiding a second attack of hypoglycaemia.…”