Dietary sugars versus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis

Carlson, Jestin N.; Schunder-Tatzber, Susanne; Neilson, Christine; Hood, Natalie

doi:10.1136/emermed-2015-205637

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…Regarding repeat treatment time, of those who were administered 20 g oral glucose, 55% of participants experienced symptomatic recovery within 5 min. This proportion increased to 89% when the treatment interval was extended to 10 min ; however, as described in the meta‐analysis , neither glucose tablets nor dietary sugars reliably restore euglycaemia within 15 min, as time is required for capillary blood samples to return to normal range.…”

Section: Resultsmentioning

confidence: 80%

“…That study found that glucose (10 g) produced a greater and more rapid plasma glucose increase (2.1 mmol/l, as compared to 0.8 mmol/l (alanine) and 1.2 mmol/l (terbutaline) at 30 min after ingestion), but glycaemic responses were more transient after glucose than after alanine and terbutaline (duration of 60 min, as compared with >8 h, respectively). A recent meta‐analysis comparing dietary sugar to glucose tablets , which included two of the above studies , as well as studies conducted on paediatric participants, found glucose tablets resulted in higher rates of symptomatic recovery at 15 min than dietary sugars, but concluded that both treatment types may be used. Regarding dosage, a diabetes clinic‐based randomized controlled trial (RCT) compared 15 g and 20 g oral glucose and found that 20 g resulted in greater symptomatic recovery at 10 min than 15 g (89% vs 63%, respectively) and thus in less total glucose requirement.…”

Section: Resultsmentioning

confidence: 99%

“…For the treatment of hypoglycaemia responding to commands, oral glucose or sucrose (tablets or solution) are the preferred source of carbohydrate for greater symptomatic recovery. While other dietary sugars may be used , glucose gel and orange juice are less effective . A dose of 20 g glucose has been advocated in preference to 15 g for providing greater symptom resolution at 10 min , and the glycaemic effects of 10–20 g of glucose may last ~60 min .…”

Section: Discussionmentioning

confidence: 99%

“…A dose of 20 g glucose has been advocated in preference to 15 g for providing greater symptom resolution at 10 min , and the glycaemic effects of 10–20 g of glucose may last ~60 min . Repeat treatment times of 10–15 min are supported, but neither glucose nor dietary sugars were found to restore euglycaemia reliably within 15 min , as individual responses vary.…”

Section: Discussionmentioning

confidence: 99%

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Emergency treatment of hypoglycaemia: a guideline and evidence review

2017

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Emergency treatment of hypoglycaemia: a guideline and evidence review

2017

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“…It is appropriate to check the blood glucose level 10 to 15 minutes after treatment 5,14,23 . As described in a meta‐analysis, 15 minutes is required to restore the euglycemia reliably 24 . A weight‐based approach was suggested to manage hypoglycemia in children, by the International Society for Pediatric and Adolescent Diabetes, as a dose of 0.3 g/kg of rapidly acting carbohydrates 5 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness of simple carbohydrates on hypoglycemic episodes in children and adolescents with type 1 diabetes mellitus: A randomized study in a diabetes camp

et al. 2020

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Background: Hypoglycemia is the most common and severe complication of insulin treatment during the management of type 1 diabetes mellitus (T1DM). Despite its importance, there is a lack of data about the efficacy and superiority of the carbohydrate sources used in hypoglycemia management in children and adolescents. Objective: We aimed to compare the effectiveness of honey, fruit juice, and sugar cubes as simple carbohydrates used in the primary treatment of hypoglycemia in children and adolescents with T1DM, who attended a diabetes summer camp. Methods: A prospective randomized study was performed in a 5-days-long diabetes summer camp. Three different types of simple carbohydrates; sugar cubes, honey, or fruit juice were randomly given for the treatment of hypoglycemia and the recovery results in the three groups were compared. Results: About 32 patients (53.1% male, mean age 12.9 ± 1.9 years) were included and 158 mild hypoglycemic episodes were observed. Sugar cubes, honey, and fruit juice were given in 46 (29.1%), 60 (37.9%), and 52 (33%) events, respectively. We found that honey and fruit juice had similar efficiency in recovering hypoglycemia in 15 minutes with a rate of 95% and 98%, respectively. However, sugar cubes had a significantly lower impact on treatment of hypoglycemia than the others, with a recovery rate of 84.7% at 15 minutes. Conclusions: This study showed, for the first time, that honey and fruit juice were more effective in treating hypoglycemia than sugar cubes, and can be preferred in treating hypoglycemic events in children and adolescents with T1DM.

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Outpatient Dietary Management of Electrolyte Disorders During COVID-19

Kwong

Liu

2021

JAMA Intern Med

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What should I eat?" is one of most common questions patients ask in the clinical setting. Patients with diabetes are asked to adhere to a low-carbohydrate diet, while patients with hypertension should consume a lowsalt diet. But truthfully, the process of calculating the milliequivalents (mEq) of each food element is tedious and often not feasible. In this essay we describe a 97-yearold patient who learned to titrate condensed chicken soup like a medicine during the coronavirus 2019 (COVID-19) pandemic. Without a doubt, this nonagenarian is a woman of great courage and wit. She first presented to the University of California, San Francisco, Nephrology and Hypertension clinic 2 years ago seeking guidance for hyponatremia management. At the age of 87 years, she had undergone a 3-vessel coronary artery bypass graft with residual reduced ejection fraction congestive heart failure. At the age of 94 years, she underwent a partial colectomy and en bloc resection of a 9-cm recurrent gastrointestinal stromal tumor. Unfortunately, for some time thereafter, she was hospitalized almost once every 2 months for heart failure exacerbations followed by hypovolemia-related hyponatremia. Eventually, her hospitalizations decreased from 6 per year to 2 per year, as she was prescribed sodium citrate-citric acid for the mild metabolic acidosis she experienced from chronic kidney disease. This both treated her acidosis and provided additional sodium content for her hyponatremia. To manage her narrow window of euvolemia, she took furosemide whenever she was above a specific weight threshold, and her laboratory tests were checked at least once a month. However, even a minor episode of gastric reflux could tip her over into hypovolemic hyponatremia despite withholding diuretics. During one of her most recent hospitalizations, her intravenous catheter had infiltrated, leading to compartment syndrome requiring surgery. Consequently, she developed a healthy fear of the hospital, which was further exacerbated by the COVID-19 shelter-in-place order implemented in the spring of 2020. In mid-April, her family called regarding her poor appetite. She was otherwise asymptomatic during her video visits, and they reported stable vital signs. Laboratory tests showed a decrease in her sodium level from 128 mEq/L to 123 mEq/L, while her creatinine level had risen from 0.92 mg/dL to 1.02 mg/dL. Her daily weights were drifting down. To better examine her volume status, we asked her to come to the clinic. Citing fears of contracting COVID-19, she refused the in-person visit. However, she reminded us that she still had cans of condensed chicken soup, which we had recommended she consume if her appetite was poor.

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Dietary sugars versus glucose tablets for first-aid treatment of symptomatic hypoglycaemia in awake patients with diabetes: a systematic review and meta-analysis

Abstract: When compared with dietary sugars, glucose tablets result in a higher rate of relief of symptomatic hypoglycaemia 15 min after ingestion and should be considered first, if available, when treating symptomatic hypoglycaemia in awake patients.

Cited by 24 publications

References 19 publications

Emergency treatment of hypoglycaemia: a guideline and evidence review

Emergency treatment of hypoglycaemia: a guideline and evidence review

Comparison of the effectiveness of simple carbohydrates on hypoglycemic episodes in children and adolescents with type 1 diabetes mellitus: A randomized study in a diabetes camp

Outpatient Dietary Management of Electrolyte Disorders During COVID-19

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