Comparison of Intravenous Glucagon and Dextrose in Treatment of Severe Hypoglycemia in an Accident and Emergency Department

Abstract

Hypoglycemia is a serious problem in insulin-treated diabetic patients. In this study the efficacy of intravenous glucagon (1 mg) was compared with that of intravenous dextrose (25 g) in the treatment of hypoglycemia in insulin-treated patients attending an accident and emergency department. In addition, the prevailing glycemic control of these patients was compared with patients routinely attending a diabetic outpatient clinic. Both intravenous glucagon and dextrose were effective in the treatment of hypoglycemic coma. There was a difference in the glycemic profile after intravenous glucagon compared with intravenous dextrose, and recovery of a normal level of consciousness after glucagon was slower than after dextrose (6.5 vs. 4.0 min, respectively; P less than .001), although the average duration of hypoglycemic coma was 1.4 h. The glucagon- and dextrose-treated groups had significantly lower HbA1 than comparable patients routinely attending the clinic (9.5 +/- 0.8 vs. 12.0 +/- 3.8%, respectively; P less than .001). In view of the ease of administration and the small risk of vascular and extravascular complications, intravenous glucagon appears to be a useful alternative to intravenous dextrose in the treatment of severe hypoglycemia.

The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man.

“…glucose). The study of Collier et al (1987) was performed with patients in an accident and emergency department, and therefore the insulin effect might be more protracted than in our study. Furthermore, the effect on glucose recovery of i.v.…”

“…and subcutaneous glucagon have been compared with each other and with oral and i.v. glucose (Collier et al, 1987;MacCuish et al, 1970;Muhlhauser et al, 1985 a,b; counterregulation Shipp et al, 1964). The glucagon in these studies derived from pancreas collection and extraction.…”

Effect of lupine as cheese base substitution on technological and nutritional properties of processed cheese analogue

“…Several previous studies were undertaken to understand how some plants which have action on the blood glucose. These plants may act on blood glucose through different mechanisms, some of them may have insulin like substances [Collier et al 1987], some may increase insulin output or inhibit the intestinal absorption of glucose or to the facilitation of metabolites in insulin dependent processes [Jia et al 2003]. Other may increase beta cells in the pancreas by activating regeneration of these cells [Shanmugasundaram et al 1990].…”

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

“…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.…”