Impact of Buccal Glucose Spray, Liquid Sugars and Dextrose Tablets on the Evolution of Plasma Glucose Concentration in Healthy Persons

Abstract

Objectives:The purpose of this prospective controlled trial was to assess the efficacy of three commercially available glucose products, (1) buccal glucose spray, (2) liquid sugars, and (3) dextrose tablet, on the evolution of plasma glucose concentration (PG).Methods: Sixteen healthy volunteers aged 21.8 ± 0.78 y (mean ± SE), BMI 23.5 ± 0.84 kg/m 2 , tested their PG over the course of 3 sets of 4 sessions (S) each: S 0 -control fasting, S 1 -buccal administration of 10 glucose spray-doses (0.84 g of glucose) without swallowing; S 2-consumption of 1 sachet (13 ml) of liquid sugar (ca. 5.2 g glucose, 5.2 g fructose, 5.2 g sucrose); S 3-consumption of one dextrose tablet (6 g). PG was tested in finger-prick capillary blood using a personal glucometer Linus at the start, and at 5, 10, 15, 20 and 30 min. The means of 3 respective sessions for each of the 16 subjects were analyzed.Results: The Wilcoxon signed rank test revealed no significant differences between changes in the mean PG at the start vs. 5-minute interval either in control, or any intervention sessions. Analysis of regression coefficients after 30 min compared to the control session, demonstrated an increase in PG with the sachet of liquid sugars (0.068 mmol/l/min, p = 0.001) which was greater than a single dextrose tablet (0.052 mmol/l/min, p = 0.002), but no significant PG increase was found after buccal glucose spray.Conclusion: Liquid sugars or dextrose tablets, but not the buccal glucose spray, are effective means to increase PG within 10 minutes after ingestion.

2020 International Consensus on First Aid Science With Treatment Recommendations

“…The SysRev identified 4 studies enrolling a total of 83 participants: 2 RCTs, studying children 9 and adults 10 with hypoglycemia, and 2 nonrandomized crossover studies with healthy volunteers. 11,12 One RCT 9 compared sublingual sugar administration (2.5 g of wet sugar under the tongue) with oral administration (2.5 g of sugar on the tongue) in a specific group of 42 children between 1 and 15 years of age with clinical signs and symptoms of acute malaria or respiratory tract infections and blood glucose concentrations between 50 and 80 mg/dL (2.8À 4.4 mmol/L) after overnight fasting. This study did not include children with severe clinical signs and symptoms of hypoglycemia.…”

“…Two nonrandomized crossover studies compared buccal glucose administration with oral administration. 11,12 The first study looked at 16 healthy fasting adult volunteers who received 10 glucose spray doses (5 doses to the buccal mucosa of each cheek, totaling 0.84 g glucose) compared with a 6 g dextrose tablet to be chewed and swallowed. 11 In the second study of 7 adults, researchers provided 15 g of instant glucose, placed between the teeth and the buccal mucosa of the cheek of each subject, and compared results with 15 g of instant glucose to be swallowed.…”

“…The subjects who received buccal glucose were encouraged not to swallow. 12 Buccal spray glucose resulted in a lower plasma glucose concentration at 20 minutes after administration compared with the chewed dextrose tablet, 11 and buccal instant glucose (ie, placed against inside cheek) resulted in fewer participants with an increased blood glucose concentration at 20 minutes. 12 Thus, both studies favored oral/swallowed glucose.…”

Hypoglycemia

“…[46][47][48] The goal of emergent therapy is to eliminate clinical signs; it may not be necessary to return the glucose to normal range. A bolus of 0.5 to 1 ml/kg of 50% dextrose (0.25 to 0.5 g/kg) can be diluted 1 : 2 to 1 : 4 and is then given intravenously over 5 minutes.…”

Immediate effect of transmucosal application of corn syrup or 50% dextrose solution on blood glucose concentrations in healthy dogs

“…The dose is empiric and recommendations range from a specific dose of 0.5–1 g/kg of body weight to a nonspecific dose of “a small amount rubbed on the gums or under the tongue.” Oral or transmucosal supplementation with dextrose solution has also been described, and this intervention has been recently recognized as effective in human neonates for prevention and treatment of hypoglycemia . Multiple studies have attempted to determine the mechanism and extent to which this buccal mucosal absorption of glucose occurs in people; results consistently demonstrated buccal mucosal absorption of sugars was not significant and may be limited to the dorsal and ventral surfaces of the tongue . Despite widespread recommendation of this treatment option for animals in acute hypoglycemic crisis, no publications to date have evaluated or quantified the effect of this route of administration in dogs.…”