IV Glucose is better than glucagon for hypoglycaemia
Date First Published:
March 1, 2000
Last Updated:
January 26, 2004
Report by:
Russell Boyd, Specialist Registrar (Manchester STEM)
Search checked by:
Bernard Foex, Manchester STEM
Three-Part Question:
In [insulin-dependent diabetic adults with accidental hypoglycaemia] does [intravenous glucose or intramuscular glucagon] provide [faster, more reliable restoration of normoglycaemia]?
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.
Search Strategy:
Medline 1966-03/00 using the OVID interface.
Search Details:
[({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 hypoglycemia OR hypoglycaemia.mp OR hypoglycemia.mp}] LIMIT to human AND english.
Outcome:
166 papers found of which 162 irrelevant or of insufficient quality for inclusion. The four remaining papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an Accident and Emergency department. Collier A, Steedman DJ, Patrick AW et al. 1987, UK | 52 consecutive insulin dependent diabetic patients with hypoglycaemic coma. IV glucagon 1mg vs IV glucose 25g | Controlled clinical trial | Recovery time to | 6.5 min vs 4 min | Not randomised. Not blinded. |
| Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an Accident and Emergency department. Patrick AW, Collier A, Hepburn DA et al. 1990, UK | 29 consecutive insulin dependent diabetic patients with hypoglycaemic coma. IM glucagon 1mg vs IV glucose 25g | PRCT | Failures | 2 glucagon failures | Not blinded. Small numbers. |
| Recovery time to | 9 min vs 3 min | ||||
| The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man Hvidberg A, Jorgensen S, Hilsted J. 1992, Denmark | 10 healthy non-diabetic subjects with experimental insulin induced hypoglycaemia. IM glucagon 1mg vs IV glucose 25g | Controlled experiment | Time to normoglycaemia | No significant difference | Non-diabetic subjects |
| A comparison of glucagon and glucose in prehospital hypoglycaemia Howell MA, Guly HR. 1997 UK | 28 insulin dependent diabetic patients with hypoglycaemic coma in the prehospital environment. IM glucagon 1mg vs IV glucose 25g | Controlled clinical trial | Time to Glasgow Coma Scale score of 15 | Significantly longer after glucagon | Block randomised. Not blinded. Small numbers. |
| TBC Carstens S et al, 1998, Denmark | 14 IDDM patients sequentially seen by a mobile ICU presenting with blood sugar< 3mmol | Randomised controlled trial of IV dextrose 50mls 50% versus IM glucagon 1mg | Time from treatment initiation to a full GCS 15 recovery | Recovery time for IV glucose mean 2.5 mins and for IM glucagon13.1 mins | Only 14 of 64 episodes actually attended were randomised. Not effectively blinded |
Author Commentary:
Although no high quality evidence exists in this area it is clear that IV glucose works faster than IM glucagon once the treatment has been given. The time to establish access has not, however, been accounted for. Glucagon "failures" have been reported.
Bottom Line:
IV glucose is the most reliable treatment for accidental hypoglycaemia. Once venous access is established it is also has the fastest effect.
References:
- Collier A, Steedman DJ, Patrick AW et al.. Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an Accident and Emergency department.
- Patrick AW, Collier A, Hepburn DA et al.. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an Accident and Emergency department.
- Hvidberg A, Jorgensen S, Hilsted J.. The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man
- Howell MA, Guly HR.. A comparison of glucagon and glucose in prehospital hypoglycaemia
- Carstens S et al,. TBC