Glucagon administration – underevaluated and undertaught

Abstract

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.

Glucagon Underutilized Among Type 1 Diabetes Mellitus Patients in Japan

“…than those previously reported from Canada (82%), New Zealand (54%), Australia (92%), and Israel (60%). [3][4][5][6] Why glucagon was underutilized in Japan remains unclear. The age of the studied patients (older than 15 years of age) might be one factor to explain the difference from previous studies mainly performed on pediatric patients.…”

The educational implications of type i diabetes mellitus: A review of research and recommendations for school psychological practice

“…Such training typically includes a general overview of diabetes and health needs, how to recognize hypoglycemia and hyperglycemia, and knowing whom to go to when there is an emergency (USDHHS, 2003). Appropriate training for handling severe hypoglycemia via glucagon injections is particularly important, given research suggesting that it is frequently mismeasured by caregivers (Harris, Diment, Sulway, & Wilkinson, 2001). Advanced training, coupled with a clear understanding of storage location and emergency protocol, are critical because there is often little time during an actual emergency to review instructions.…”

Intranasal Glucagon

“…In its current form, administration of glucagon is, in fact, an invasive and relatively complex medical procedure, and therefore it is underprescribed, undertaught, and underused. 20 This leads to suboptimal use of an otherwise effective medication, to unnecessary delays in treatment and costly use of emergency medical systems including ambulance services, emergency room visits, and hospital admissions.…”

“…This reduces the ready application of current glucagon products by lay people and when used, can result in suboptimal outcomes (eg, through delayed administration, errors in treatment, and delays in receiving medical assistance). In a study in which parents of children and adolescents with type 1 diabetes used a currently available glucagon kit (GlucaGen® HypoKit, Novo Nordisk) in a simulated emergency situation, 20 parents were given an emergency glucagon kit and asked to administer the medication into a wrapped piece of meat to simulate a thigh. Of the 136 parents who participated in the study, all trained on use of glucagon, 69% experienced difficulties in handling the glucagon kit (opening the pack, removing of the needle sheath, mixing the ingredients, and bending needles).…”