# Oral Glucose Question



## Guardian (Aug 10, 2007)

Can oral glucose be absorbed into the bloodstream via buccal administration?  Or, do they teach emts to give it this way to prevent choking.


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## Ridryder911 (Aug 10, 2007)

Oral glucose is allowed and recommended for several reasons. Yes, it is more rapidly absorbed & entered through the bucosal/mucosa route, it is easy to administer, cheap, and very little danger to it. 

Now, if the patient has < LOC; caution should be taken; making sure that the patient is in a recovery position and monitor the airway and suction PRN. Choking and aspiration can still occur, since the preventive reflexes are absent.  

There is another route that glucose syrup could be administered, but doubtful most would prefer to give it...


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## BossyCow (Aug 10, 2007)

Ridryder911 said:


> There is another route that glucose syrup could be administered, but doubtful most would prefer to give it...



Ewwwww...... sticky!


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## emtskibum (Aug 10, 2007)

There is another route that glucose syrup could be administered said:
			
		

> yea, i doubt that as well


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## Guardian (Aug 11, 2007)

Ridryder911 said:


> Oral glucose is allowed and recommended for several reasons. Yes, it is more rapidly absorbed & entered through the bucosal/mucosa route, it is easy to administer, cheap, and very little danger to it.
> 
> Now, if the patient has < LOC; caution should be taken; making sure that the patient is in a recovery position and monitor the airway and suction PRN. Choking and aspiration can still occur, since the preventive reflexes are absent.
> 
> There is another route that glucose syrup could be administered, but doubtful most would prefer to give it...




So what you're saying is it can be absorbed through the gum directly into the bloodstream?  Furthermore, you're saying this is faster than being absorbed through the GI system if swallowed?

This is what I've been taught since emt-b class years ago.  The reason I bring this up is...I can only do bls at my volly fire station and I gave a little oral glucose to a pt with decreased BGL.  The AIC from EMS who is a CCEMT-P like me, walks in and tells me to stop giving the glucose buccally because "the glucose molecules are too big to be absorbed through the tissue."  I respect (or at least I did) this mans knowledge and was wondering if this was a controversial/debatable issue or if there are any new points of view on the subject.


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## MMiz (Aug 11, 2007)

I can't remember this being even somewhat controversial, and I've even seen ALS give it via the oral route (I had to look up buccally).

It's clearly not as fast as some D50, the miracle drug, but it definitely works.


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## Guardian (Aug 11, 2007)

MMiz said:


> I can't remember this being even somewhat controversial, and I've even seen ALS give it via the oral route (I had to look up buccally).
> 
> It's clearly not as fast as some D50, the miracle drug, but it definitely works.



I know it can be given orally.  There are two different routes orally.  There is the buccal route, in which the drug is absorbed into the gums (like chewing tobacco or nitro) and the other is ingestion where the drug is swallowed and absorbed through the GI system (like food).  The question is, can it be given buccally?  The fact a highly respected paramedic says no has given me some doubt.


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## MMiz (Aug 11, 2007)

Truthfully, I've always seen it given buccally.  My protocols instruct me to either squeeze it in an area around the patient's gums, or put it on a tounge depressor and stick it in there.

Maybe it's because I've always been with ALS and they'd just put in a line of D50 if the patient required a significant amount.  I'm not sure.


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## Ridryder911 (Aug 11, 2007)

Although, glucose molecules are large, they still can be absorbed through the buccaly or mucosa. Technically, most of it is being absorbed through mucosa and some even into the GI tract. 

One could argue about how much, is really being absorbed versus adsorbed (there really is a difference), and carbohydrate and transferring proteins.. blah, blah... It does not matter. The point is to get some glucose into the system to prevent the break down of fats to be used as sugar. It does not take that much sugar content to prevent insulin shock from occurring. 

That is why for years before oral glucose, honey was used SL or mucosa route. Egyptians to Native Americans; have been treating such for centuries way prior to modern medicine. Even a sugar slur (sugar and water made into a paste) has been used. 

I have even seen D50w given p.o., when there has not been any glucose product available. The problem with any glucose additive (including D50w) is it is rapidly adsorbed and metabolized. This is why it is essential that the patient should have protein with it. After one has increased the LOC, a high protein, even high carbohydrate snack .. (pizza is great!) will increase glucose plus have some staying power, that will not allow the glucose to drop as rapidly. 

Like I have said, one can adminster glucose different routes.. the choice is dependent on the patient condition and the availability at the time.


R/r 911


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## Guardian (Aug 12, 2007)

Ok, as far as I'm concerned, I'm now confident that my instincts, education, etc, were correct and he was totally wrong.  

This brings up a couple of sidebars though.  One, it's really interesting to see how some paramedics (especially paid) treat emts (especially volunteer).  I see this all the time because a lot of the paramedics in my volly area don't know I'm a paramedic in the city and just assume I'm an emt.  This is because I don't like to broadcast and brag that I'm a paramedic.  This allows me to get an "undercover" view of how emts are treated.  And trust me, I'm not always happy with what I see.  Instead of him telling me the truth, he was impatient and didn't feel that the oral glucose was necessary considering D50 was going to be given soon.  He got lazy and came up with some stupid short bogus explanation for me to stop giving the oral glucose.  What if I had been an impressionable new emt.  I would have probably gone on believing this was true.  I guess this is why, more and more, I believe people should be able and even encouraged to go straight to paramedic without the "valuable" experience as a basic provider.  Two, I would encourage all of the current emts to question everything they hear from their ALS providers (probably not a good idea to do this on scene).  Why, because they have an amazingly well honed ability of sounding like they know what they're talking about when many really don't have a clue or are just feeding you a load on purpose.  Not trying to start any debate here, just sharing some observations and opinions.


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## Ridryder911 (Aug 12, 2007)

Just to prove there are "jerks" no matter if they are paid to be or volunteer to be.. 

The problem is that instead of dealing diplomatically, and describing that "he preferred to administer IV D50w, because they would know exactly how much sugar is given or even that he preferred not to give anything p.o., that is another. To apparently flaunt, is not impressing anyone. As my sister with a PhD describes, ..."there is no fool, like an educated fool"... 

Truthfully, he is partially right, as well as wrong too. One can get into great detail of absorption portions of carb's and glucose metabolism.... as I said , Yadda, Yadda... the patient needs sugar.. now! 

I might suggest reading JEMS as well, a few months ago there was an article in regards of administering D25W in lieu of D50w. I personally, hardly ever administer D50w due to rebound effect and potential necrosis. Studies have demonstrated that low glucose can be effective treated with D25w & even D10w. The only time I administer pure D50w, is when they are severely hypoglycemic (<25mg/ml) and then slowly administer with fluids. 

I have learned over the past 30 years, when dealing with people; it is much easier to attract flies with honey than vinegar. Even when some may only offer nothing more than moral support, it is better to have them to think kindly of you.. 

R/r 911


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## Arkymedic (Aug 14, 2007)

*Just sidebar*

I believe that the topic has been well covered so my two sense is not needed however I just wanted to remind those that use it and those that might be adding it to a bag that cake icing is much cheaper, easier to replace, and works just as well as oral glucose does.


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## Asclepius (Aug 14, 2007)

Guardian said:


> So what you're saying is it can be absorbed through the gum directly into the bloodstream?  Furthermore, you're saying this is faster than being absorbed through the GI system if swallowed?
> 
> This is what I've been taught since emt-b class years ago.  The reason I bring this up is...I can only do bls at my volly fire station and I gave a little oral glucose to a pt with decreased BGL.  The AIC from EMS who is a CCEMT-P like me, walks in and tells me to stop giving the glucose buccally because "the glucose molecules are too big to be absorbed through the tissue."  I respect (or at least I did) this mans knowledge and was wondering if this was a controversial/debatable issue or if there are any new points of view on the subject.



Are you sure he wasn't talking about the molecules in IV D50? That causes tissue necrosis. Maybe he was trying to make a point about something he was not clear on himself?


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## Guardian (Aug 14, 2007)

Yea, I'm sure.  You can give D50 orally without tissue necrosis.  I've done it.


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## emtmomof2 (Aug 14, 2007)

It seems that the medics here in my area don't have a problem with it.  Yes it is a slow process with the glucose..it only brings the numbers up a couple of points, but it is protocol here in nj to give it to the patient if alert...it is just something that we can do till medics arrive...we have some problems with some medics here treating us like we are idiots...however majority of the medics are great...


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## BossyCow (Aug 14, 2007)

We've always done it that way.  I've never heard of an objection to it.  Perhaps the medic was fresh from a seminar?


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## Ridryder911 (Aug 14, 2007)

What I believe the Paramedic was thinking of (IMHO) was protein molecules such as Glucose and some others cannot be passed through membrane easily. Due to the size, and osmolality some chemicals are restricted. I have not read or seen any changes recently and from what I have read of current literature, can still be absorbed through the mucosa. 

Yes, D50w can be drink without necrosis due to the acidity in the gastric and it is not introduced into the layers of the tissue. There are many IV med.'s that are absorbed p.o.; but the main question would be *why?* 

Give some sugar solution and be done with it, I prefer the KISS method! 

R/r 911


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## shrevo23 (Aug 15, 2007)

On the lighter side of this topic, isn't it kinda funny that when administering insta-glucose it seems to find it's way onto everything in the back of the rig. Man that stuff is sticky.


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## Alan Jones (May 29, 2018)

I disagree I think the evidence shows  the opposite


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## Alan Jones (May 29, 2018)

I know this thread is old, but just saying, this thread comes to the absolute opposite conclusion as does a thread on a similar EMT website called EMT city [It won't let me post the link-- Search on that site for a thread titled "Transmucosal glucose and evidence based medicine" posted by Asysin2leads]


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## Alan Jones (May 29, 2018)

The thread on that site cited (just one) source, whereas this thread has cited zero. Any other sources? This is a 1978 article. It says glucose is *not* able to be absorbed buccally

JAMA 1978 Oct6;240(15):1611-2
"Bioactivity of instant glucose. Failure of absorption through oral mucosa"
Pubmed 691147
[Someone post the links for me it won't let me post links to other websites]

Thus it does not make sense to administer in the cheeks unless you think it can be swallowed

Was there a more recent study that showed the opposite? Otherwise looks like you should definitely *not* expect this to work at all.


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