Article Text

PDF

Glucose or glucagon for hypoglycaemia
  1. Russell Boyd,
  2. Bernard Foëx
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

    Statistics from Altmetric.com

    Report by Russell Boyd, Specialist Registrar Search checked by Bernard Foëx, Specialist Registrar

    Clinical scenario

    An insulin dependent diabetic adult is brought into the emergency department uncooperative and acutely confused. A blood glucose stick test confirms hypoglycaemia. You wonder whether parenteral glucose or glucagon is the drug of first choice.

    Three part question

    In [insulin dependent diabetic adults with accidental hypoglycaemia] does [intravenous glucose or intramuscular glucagon] provide [faster, more reliable restoration of normoglycaemia]?

    Search strategy

    Medline 1966–03/00 using the OVID interface. [({exp glucose OR glucose.mp OR dextrose.mp} AND {IV.mp OR exp injections, intravenous OR intravenous.mp}) AND {exp glucagon OR glucagon.mp} AND {exp hypoglycaemia OR hypoglycaemia.mp OR hypoglycemia.mp}] LIMIT to human AND english.

    Search outcome

    Altogether 166 papers were found of which 162 irrelevant or of insufficient quality for inclusion. The four remaining papers are shown in table 6.

    Comment

    Although no high quality evidence exists in this area it is clear that intravenous glucose works faster than intramuscular glucagon once the treatment has been given. The time to establish access has not, however, been accounted for. Glucagon “failures” have been reported.

    Clinical bottom line

    Intravenous glucose is the most reliable treatment for accidental hypoglycaemia. Once venous access is established it is also has the fastest effect.

    Report by Russell Boyd, Specialist Registrar Search checked by Bernard Foëx, Specialist Registrar

    References

    View Abstract

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.