Glucagon: Prehospital therapy for hypoglycemia

Vukmir, R. B.; Yealy, DM

doi:10.1016/s0196-0644(89)80811-x

Cited by 15 publications

(18 citation statements)

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“…30 Almost 40 years later, recombinant glucagon was approved in 1998 and is widely used for the emergency rescue of hypoglycemia in patients with diabetes. [30][31][32][33] Glucagon is now recognized as the primary counterregulatory hormone in individuals without diabetes, which increases blood glucose at the time of insulin induced hypoglycemia by stimulating hepatic glycogenolysis. 1,[34][35][36] It is secreted by the alpha cells of the pancreas in response to 3 main stimuli: (1) a decrease in ambient glucose concentrations by a direct effect of low glucose on the alpha cell, 37,38 (2) the removal of the insulin inhibitory effect on the alpha cell, 39 and less importantly, (3) through stimulation of the autonomic nervous system.…”

Section: Glucagon Discovery and Actionmentioning

confidence: 99%

“…31,32 The recommended glucagon dosing is weight based: 1 mg for adults and children >20 kg and 0.5 mg or 20 to 30 μg/kg for children <20 kg, (Eli Lilly product/labeling insert), but the evidence for these recommendations is unclear. In normal volunteers, a 1 mg injection of glucagon results in a 1.9-3.1 mmol/l rise in blood glucose within 30 minutes and plasma glucagon concentrations of 6000-7000 pg/ml (Eli Lilly product/labeling insert).…”

Section: Glucagon Therapymentioning

confidence: 99%

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Minimizing Morbidity of Hypoglycemia in Diabetes

Chung

Haymond

2014

J Diabetes Sci Technol

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Type 1 diabetes is a common chronic disease of childhood and one of the most difficult conditions to manage. Advances in insulin formulations and insulin delivery devices have markedly improved the ability to achieve normal glucose homeostasis. However, hypoglycemia remains the primary limiting factor in achieving normoglycemia and is a frequent complication in children with acute gastroenteritis and/or poor oral intake. In situations of impaired carbohydrate intake or absorption, glucagon therapy is the only out-of-hospital treatment option available to families and caregivers. Glucagon is recommended for the treatment of severe hypoglycemia and rapidly increases blood glucose by increasing hepatic glucose production from glycogenolysis. Mini-dose glucagon is a widely utilized off-label treatment for managing mild or impending hypoglycemia and is administered as a small subcutaneous injection. It was initially described for use in children who were unable to tolerate or absorb oral carbohydrates but not in need of advanced medical care. Yet, mini-dose glucagon may be useful in any individual with relative insulin excess. The regimen aims to prevent severe hypoglycemic episodes and is safe, effective, and easily administered by patients and caregivers in the out-of-hospital setting. By empowering patients and their families, this important tool could help to alleviate the physical, psychosocial, and financial burden evolving from impending hypoglycemia.

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Section: Glucagon Discovery and Actionmentioning

confidence: 99%

Section: Glucagon Therapymentioning

confidence: 99%

Minimizing Morbidity of Hypoglycemia in Diabetes

Chung

Haymond

2014

J Diabetes Sci Technol

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“…1 Glucagon injections have been recommended for many years as the treatment of choice for hypoglycaemic coma experienced in the nonhospital setting. 2,3 We were initially alerted to the practical problems associated with the administration of glucagon by some parents of teenagers who reported that they felt distressed and inadequate about their inability to manage the procedure under pressure. 'Three am was not the time to read the instructions with a teenager unconscious and fitting'.…”

Section: Introductionmentioning

confidence: 99%

Glucagon administration – underevaluated and undertaught

et al. 2001

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Glucagon treatment requires a manually dexterous 'operator' who is composed, confident and competent in the whole procedure. Anecdotal reports from parents of teenagers describing difficulties in administering this procedure during severe hypoglycaemia led us to investigate the 'techniques' of 136 parents (106 parents of teenagers and 30 parents of young children). A simulated administration by parents using Novo Nordisk Glucagen 1 Hypokits was timed, rated and compared with a group of diabetes health professionals. Parent's 'real life' experiences of education and administration were obtained with a standard questionnaire. Glucagon residues in syringes and vials were estimated in a laboratory. Sixty nine per cent had handling difficulties ranging from opening the container to drawing the correct dose into the syringe. There was no statistical difference in time taken to complete the procedure between the two parent groups. However there was a significant difference between parents and the professional group. Parents were not accurate in administering dosages as recommended. Young children weighing more than 25 kg would have received less than the required dose. All parents reported verbal instruction with demonstration of the procedure at initial education. We suggest that glucagon administration needs to be taught 'hands on' and the skill reassessed on an annual basis.

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“…Because it has been demonstrated that headache may occur in patients with diabetes and in patients treated with glucagon for the correction of low blood glucose levels [25], hypoglycemia appears to play a fundamental role in the pathogenesis of fasting headache. Considering the central role played by glucose in brain metabolism, it is then reasonable to assume that in genetically predisposed individuals, even small fluctuations in blood glucose levels may induce alterations in the nociceptive system of the brain, causing headache.…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

Fasting Headache

Torelli

Manzoni

2010

Curr Pain Headache Rep

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Headache is a common disorder in the general population. Fasting headache is coded to Group 10 of the second edition of the International Classification of Headache Disorders ("Headache attributed to disorder of homeostasis"). A study conducted in Denmark's general population found a lifetime prevalence rate of 4.1% for fasting headache. Fasting headache is usually diffuse or located in the frontal region, and the pain is nonpulsating and of mild or moderate intensity. In most cases, the headache occurs after at least 16 h of fasting and resolves within 72 h after resumption of food intake. The likelihood of developing fasting headache increases directly with the duration of the fast. Headache sufferers have a higher risk of developing headache during fasting than people who do not usually suffer from headache. Hypoglycemia and caffeine withdrawal have been especially implicated as causative factors, but much remains to be understood about this topic.

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Glucagon: Prehospital therapy for hypoglycemia

Cited by 15 publications

References 0 publications

Minimizing Morbidity of Hypoglycemia in Diabetes

Minimizing Morbidity of Hypoglycemia in Diabetes

Glucagon administration – underevaluated and undertaught

Fasting Headache

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