Glucagon Treatment of Insulin Reactions

Elrick, Harold; Witten, Thomas A.; Arai, Y.

doi:10.1056/nejm195803062581005

Cited by 52 publications

(20 citation statements)

References 5 publications

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“…Her plasma glucose on arrival at the accident and emergency department was 56 mg/dl (compared with mean initial plasma glucose of 18 mg/dl), and she had borderline grade 3 level of consciousness. DISCUSSION T his study confirmed that glucagon is effective in the treatment of severe hypoglycemia, giving a predictable rise in plasma glucose (7)(8)(9)(10). Although the return to a normal level of consciousness was slower than with dextrose, the difference was small (2.5 min), especially when compared with average duration of hypoglycemia experienced by these patients (1.4 h).…”

Section: Resultssupporting

confidence: 71%

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

Collier

Steedman²,

Patrick³

et al. 1987

Diabetes Care

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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.

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Section: Resultssupporting

confidence: 71%

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

Collier

Steedman²,

Patrick³

et al. 1987

Diabetes Care

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“…Our results confirm the findings of others (Elrick et al, 1958;Shipp et al, 1964;Aman & Wranne, 1988), in demonstating that intramuscular glucagon is effective in restoring the plasma glucose level towards normal, even following prolonged hypoglycaemic coma, as was the case in many of the patients reported in the present study. The rate of recovery was, however, slower than that reported following intravenous glucagon in a similar study in an accident and emergency department (Collier et al, 1987) and this finding might be expected on the basis of previous research into the pharmacokinetics of glucagon, with higher plasma levels being obtained during the first 15 min after intravenous glucagon in comparison with either intramuscular or subcutaneous administration (Muhlhauser et al, 1985).…”

Section: A W Patrick Et Al Discussionsupporting

confidence: 94%

Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department.

Patrick

Collier

Hepburn

et al. 1990

Emergency Medicine Journal

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SUMMARYHypoglycaemia remains a serious and much feared complication of insulin therapy. In this study, patients attending an accident and emergency department in hypoglycaemic coma were randomized to treatment with either intravenous dextrose (25g) or intramuscular glucagon (lmg), administered into the right thigh. Restoration of normal conscious level was slower after glucagon than dextrose (90 vs 30 min, P<0-01), although the average duration of hypoglycaemic coma was 120 min. Two patients in the glucagon-treated group, who failed to show satisfactory recovery after 15 min, required additional treatment with intravenous dextrose. On questioning following recovery, all except two patients reported loss of awareness of the onset of hypoglycaemia.Intramuscular glucagon is valuable in the treatment of severe hypoglycaemia outwith hospital and, although the slightly slower and less predictable recovery may appear to make it a less attractive option than intravenous dextrose in the accident and emergency department, this must be balanced against the advantages of ease of administration and a lower incidence of serious adverse effects.

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“…Parents, relatives, spouse, flatmates or partners should be familiar in glucagon administration and the subsequent follow-up treatment. 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.…”

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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Glucagon Treatment of Insulin Reactions

Cited by 52 publications

References 5 publications

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

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

Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department.

Glucagon administration – underevaluated and undertaught

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