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Prehospital Treatment of Severe Hypoglycaemia: A Comparison of Intramuscular Glucagon and Intravenous Glucose

  • Søren Carstens and Michael Sprehn
Abstract
Introduction:

By introducing an intensified insulin treatment regime to patients with insulin-dependant diabetes mellitus (IDDM), the frequency of long-term complications that the patient will experience has been shown to decrease. The price is an increase in the frequency of severe and mild hypoglycaemic events. Therefore, constant monitoring of these patients is necessary.

Hypothesis:

This study compares the time until full recovery of IDDM patients with severe hypoglycaemia after treatment with either intravenous glucose or intramuscular glucagon.

Methods:

14 patients with IDDM with severe hypoglycaemia requiring treatment by the medical staff was randomised to treatment either with 50 ml of 50% glucose intravenously or intramuscular 1 mg glucagon. The time to recovery was recorded. Plasma glucose was measured at fixed intervals to achieve a glycaemia profile. Demographic data were acquired through patient interviews following recovery.

Results:

Recovery time between the two groups was significantly different statistically. Recovery time ranged for 1 to 3 minutes for those receiving glucose intravenously and 8 to 21 minutes for those receiving intramuscular glucagon. Characteristic glycaemia profiles were identified and differences were present between the two groups with a greater fluctuating pattern for the glucose group compared to the steadily increasing pattern seen after glucagon treatment. Alcohol was believed to be involved in 8 out of the 14 cases, and thereby, is the major confounding factor in this study.

Conclusion:

Intramuscularly administered glucagon is a safe and reliable alternative to intravenous glucose infusion. The fluctuating glyceamia pattern seen after glucose treatment indicates a low risk for secondary hypoglycaemia. However, further studies are necessary to support this assertion.

Copyright
Corresponding author
Mobile Intensive Care Unit, Municipal Hospital Copenhagen, Øster Farimagsgade 5. DK-1399 København K. Denmark
References
Hide All
1. Tunbridge, WM: Factors contributing to deaths of diabetes under 50 years. Lancet 1981;2(8246):569572.
2. Tattertall, R: How common is death from insulin-induced hypoglycaemia? I: Ferderlin, K, Keen, H, Mehnert, H, (eds). Hypoglycaemia and human insulin. Stuttgart: Georg Tbiemes Verlag 1991;1523.
3. Reinchard, P, Britz, A, Cars, I et al. : The Stockholm Diabetes Intervention Study (SDIS): 18 months results. Acta Med Scand 1988; 224:115122.
4. Reinchard, P, Rosenqvist, U: Nephropathy is delayed by intensified insulin treatment in patients with insulin-dependant diabetes mellitus and retmopathy. J Inten Med 1989;226:8187.
5. Reinchard, P, Berglund, A, Britz, A et al. : Hypoglycaemic episodes during intensified insulin treatment: Increased frequency but no effect on cognitive function. J Intern Med 1991;229:916.
6. Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependant diabetes mellitus. N Engl J Med 1993;329:977986.
7. Collier, A, Steedman, DJ, Patrick, AW et al. : Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycaemia in an accident and emergency department. Diabetes Care 1987;10:712715.
8. Eldrick, H, Witten, TA, Arai, Y: Glucagon treatment of insulin reactions. N Engl J Med 1958;258:476480.
9. Vukmir, RB, Paris, PM, Yealy, DM: Glucagon: Prehospital therapy for hypoglycaemia. Ann Emerg Med 1991;20:375379.
10. Steel, JM, Allwinkle, J, Moffat, R, Carrington, DJ: Use of Lucozade and glucagon by ambulance staff for treating hypoglycaemia. BMJ 1992;304:12831284.
11. Patrick, AW, Collier, A, Hepburn, A et al. : Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med 1990;7:7377.
12. Trinder, P: Determination of Glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem 1969;6:2427
13. Shaffer, M, Stroupe, S: A General method for routine clinical chemistry in the ABBOTT TDx Analyzer. Clin Chem 1983;23:6:1251. (Abstract).
14. Hepburn, DA, Patrick, AW, Eadinton, DW et al. : Unawareness of hypoglycaemia in insulin treated diabetic patients: Prevalence and relationship to autonomic neuropathy. Diabetes Med 1990;7:711717.
15. Seltzer, HS: Drug-induced hypoglycaemia. A review based on 473 cases. Diabetes 1972;307:11061112.
16. Cohen, S. A review of hypoglycaemia and alcoholism with or without liver disease. Ann NY Acad Sci 1976;273:338342.
17. Unger, RH: Meticulous control of diabetes. Diabetes 1982;31:479483.
18. Kallas, P, Sellers, EM: Blood glucose in intoxicated chronic alcoholics. Can Med Assoc J 1975;112:590592.
19. Linde, J, Nilson, LH, Barany, FR. Diabetes and hypoglycaemia and chronic pancreatitis. Scand J Gastroenterol 1977;12:369373.
20. Pons, PT, Moore, EE, Cusick, JM et al. : Prehospital venous access in an urban paramedic system. J Trauma 1988;28:14601463.
21. Herbst, C: Indications, management and complications of percutaneous subclavian catherization. Am J Surg 1979;136:869874.
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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