Glucagon vs IV Dextrose

the_negro_puppy

the_negro_puppy

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Hi,

Just a quick question regarding glucagon and IV dextrose.

My service uses glutose gel, IM glucagon and IV glucose 10% to treat hypoglycaemia.

I am learning glucagon for my next assessment.

My question is this:

What cases pt/condition would you use IV glucose over glucagon. Obviously IM glucagon will take longer for effects but with IV glucose you obviously have to gain IV access first.

Im thinking IV glucose in most cases of unconcncious/ALOC hypo episode as once you have access you can easily give more glucose/other drugs whereas IM is one use.

Cheers
 
Malnutrition, alcoholics, people who don't have enough glycogen stores in their livers to let Glucagon be effective.
 
Linuss said:
Malnutrition, alcoholics, people who don't have enough glycogen stores in their livers to let Glucagon be effective.
Click to expand...

Very true.

Which do you guys prefer to go with, if you had a choice between two?

I guess one benefit of IM is that if they are aggresive / aloc due to hypo the cant rip the line out etc.


Is glucagon outdated? Seems iv glucose is the global standard
 
Glucagon still has it's place (eg beta blocker overdose)

Plus, we can do Glucagon IV, IM and IN via the MADD, so I have a lot more options of when / how to use it than D5/10/25/50.


I suck with IVs lately... therefor Glucagon might see a use sometime soon.
 
Young insulin dependant diabetic kids is another time gulcagon might not work.

Can you leave your uncomplicated hypos at home like we can?
 
MrBrown said:
Can you leave your uncomplicated hypos at home like we can?
Click to expand...



???



hungry%20hungry%20hippo.jpg
 
That's right, feed 'em gumballs and split.

Hungry, hungry hypos.

Good one-two punch, glucagon then IV gluc. Just keep the neele happy folks from slamming more glucagon when they don't see an upswing in a minute.

Oh, yes, then a PEANUTBUTTER SANDWICH!!
 
We can. Well, in reality we can leave nearly anyone at home who insists on being left home, but yes, we can leave hypos at home once they are "fixed".

Overall, I prefer oral sugar/carbs. It saves the veins, and allows for a more even blood sugar increase, instead of sending them all over the place.

In the cases were oral glucose isn't appropriate, what I use totally depends on the pt. If the pt is very young, very old, septic, malnourished etc I stick with IV dextrose. Also, if the pt is at the gym, or competing in an athletic event, just because you really have no idea what their glycogen stores look like. Healthy hard-core athletes can deplete their stores under the right situations.
 
If we go to a hypo who has recoverd normally, hasn't done something silly like have a seizure or injured themselves, has access to a complex carbohydrate and somebody to look after them for the next couple hours we can (and often do) leave them at home.
 
the_negro_puppy said:
Hi,

Just a quick question regarding glucagon and IV dextrose.

My service uses glutose gel, IM glucagon and IV glucose 10% to treat hypoglycaemia.

I am learning glucagon for my next assessment.

My question is this:

What cases pt/condition would you use IV glucose over glucagon. Obviously IM glucagon will take longer for effects but with IV glucose you obviously have to gain IV access first.

Im thinking IV glucose in most cases of unconcncious/ALOC hypo episode as once you have access you can easily give more glucose/other drugs whereas IM is one use.

Cheers
Click to expand...

great question.
We use IM Glucagon as a backup, when ya have the day when you can't hit the broad side of a barn with a 24, or the pt left their veins in their other skin.
Also hit on was the point of Glucagon IVP for Beta Blocker ODs.
Look into the special considerations for that, as there are a couple.
 
Linuss said:
Glucagon still has it's place (eg beta blocker overdose)
Click to expand...


Does anyone actually carry enough of Glucagon to be effective in the event of a Beta-Blocker OD? I've heard it takes a lot more than the 2 or 3mg carried on most units. (being that Glucagon is rather expensive)
 
terrible one said:
Does anyone actually carry enough of Glucagon to be effective in the event of a Beta-Blocker OD? I've heard it takes a lot more than the 2 or 3mg carried on most units. (being that Glucagon is rather expensive)
Click to expand...

Given that the doses usually recommended are between 1-5mg 5 minutely, I would be surprised! Which is not to say that I wouldn't be using the few units we carry, but I wouldn't be wasting time in scene either :)
 
I suppose traditionally, glucagon was used at the Ambulance officer level because they didn't have IVs. Then when they did, the high command didn't trust them with D50...that was still secret MICA business ;)

Nowadays, with our fancy IV glucose, glucagon still has a role.

At the Ambulance paramedic level (Advanced care paramedic in QLD?) we cannot cannulate paeds, so theres that.

For consideration in a pt showing poor response to oral glucose.

Failed IV.

This is a little controversial but some people like to use it in hypoglycaemic seizures, because of the obvious difficulty getting an IV and I think people get the collywobbles about midazolam. I'm of the view that a continuous seizure needs terminating. I'd prefer not to wait around for 10 minutes wondering whether or not the glucagon is working or whether or not it was even a hypo-G seizure in the first place while the patients brain blends itself into a tasty protein shake.
 
We have it in our protocols specifically for Beta blocker overdose, yet we only carry 2-3mg.
 
Length of ride versus mg per minute determined by pt weight and meatabolism

Also, as far as terminating hypoglycemic seizures, need to stop the seizures to allow respiration, but also need to feed the brain.
I also strongly favor oral gluc fast when there's any chance of hypoglycemia, to prevent it going over the falls in a washbasket.

On glycogen reserves, exactly how badly depleted do you have to be for it to be ineffective, and would a quick shot harm the pt as you porceed to other matters? Are we talking someone who missed a couple meals, or a long distance runner or alky with no body fat?
 
Last edited by a moderator:
Well I got to see for myself.

The other day got called to a Diabetic patient who had collapsed/been unconscious for a period of time

Pt was GCS 14 sitting/lying on the ground said he felt weak and unable to stand up. IDDM. His initial BSL was 3.2. We started with glucose gel and a honey sandwich, also gained IV access. But after 10 minutes his BSL went down to 2.3. We gave hime 150ml 10% IV glucose which brought it up to 7.7. then 11.0 as we got to hospital. We decided to transport this pt due to his poor initial response and that he did not have a history of Hypos.
 
Glucose 10%?
Why not glucose 50% 20cc i.v.?
When effect is zero, than again 20cc glucose 50% i.v.
After giving glucose flush with NaCl 0,9% 5cc.
effect within a couple minutes.
In Netherlands all ambulances have glucose 50% in 50cc bottles.
 
What if you can't get a line?:rolleyes:
 
Dutch-EMT said:
Glucose 10%?
Why not glucose 50% 20cc i.v.?
When effect is zero, than again 20cc glucose 50% i.v.
After giving glucose flush with NaCl 0,9% 5cc.
effect within a couple minutes.
In Netherlands all ambulances have glucose 50% in 50cc bottles.
Click to expand...

We use 10% on everyone now after some research showed it was much better at achieving the desired results without causing large peaks in glucose levels with a concomitant hypo. Much better when we're leaving most of those people at home. Also its safer in terms of tissue necrosis.
 
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