Glucagon vs IV Dextrose

Aidey said:
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.
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Aidey hit on the one point that I wanted to make in this discussion. Remember that for your noncompliant diabetics....

Dialysis is probably in the cards. The more scarring of veins (especially since most EMTs always go for the AC) the more at risk they are for having unusable vessels when it comes time for dialysis access.

Don't forget, this is not their first rodeo and most certainly not the last.
 
Melclin said:
Also its safer in terms of tissue necrosis.
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With that i fully agree! It's a disaster for a vein.
Ofcourse we use glucagon as well...

When leaving a patiënt at home, always the GP will be called to see his patiënt and deal with the care after the ambulance-care
 
Sam Adams said:
I've heard rumor of glucagon being used for esophageal spasm, never heard of this one....
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It can be used as smooth muscle relaxant in a FBAO. I have seen it used once in the field years ago, it was unsuccessful and was eventually removed by endoscopy.
 
One of the funniest calls we had, was a pt whose BGL was low, a known diabetic, don't remember the exact number, but she was alert, oriented, and functioning, just a bit woosie. It was Easter morning, and low and behold what do I see sitting on the counter in an Easter basket, YUP, a Cadbury cream egg! It worked awesome, LOL! :)
 
I couldn't get an IV last night on a diabetic pt. tried 3x and then resorted to IM glucagon. Pt had a CBG of 51 but was conversing, slow to respond and somewhat confused. Ten minutes after administration CBG increased to 78.

I had another one that I did get an IV on and they got a AMP of D50 and then a D5W drip TKO.
 
MrBrown said:
Young insulin dependant diabetic kids is another time gulcagon might not work.

Can you leave your uncomplicated hypos at home like we can?
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We could. Completing the protocol ("Witness the patient eating something containing protein and complex carbohydrates") was how I got to meet one of the last surviving WWI veterans in the US.
 
Got trained on Glucose 10% today and was told that if oral glucose cannot be given then we should then go IV access and glucose 10%. Glucagon only to be given if difficulty in obtaining access and giving 10%
 
If they person is unable to swallow I'll use Dextrose instead of Glucagon.
 
clibb said:
If they person is unable to swallow I'll use Dextrose instead of Glucagon.
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I hope you mean IV, if you give D50 IM then you are going to cause some major necrosis.

I could not obtain IV and I was not comfortable giving him oral glucose due to his LOC, so IM glucagon.
 
I think you are thinking of Glucose!
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No, if they can't swallow it's either IV dextrose or IM glucagon.
 
Oral glucose and food for the patient able to swallow, Glugagon for Hard sticks, siezing patients, etc. IV dextrose for the patient that gets a quick IV. I usually give the D50 really slow and sometimes start with 12.5mg and work slowly.

We treat and release hypo patients when it is appropriate.
 
Glugagon for Hard sticks, siezing patients, etc
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Personally, I always thought starting out with the glucagon (unless you had a reason to suspect it would not work) was a good way to get the patient conscious so you could give oral glucose and save the headache of trying to start an IV. Then again, for most of my prehospital career, I had a very practical medical director who saw that as a valid argument.
 
We usually will have at least 2 medics on scene but normally 3. We have 2als/2bls engines and 1/1 rescue ambos. So we usually have enough hands to have 1 look for a good vein, another get the glucagon ready. I think it is a good idea to use it first. We are looking into the IN route since we are getting protocol for IN narcan and versed.

Also it was discussed above, I am all for stopping the siezure as soon as possible instead of waiting and hoping that glucagon works. We have versed on hand for that as well.
 
I'm a new paramedic and amazingly I've never once pushed dextrose IV. We carry both but our protocol states to hold on the glucagon unless we can't get an IV. In the case of a hypoglycemic seizure, however, I could see where going with glucagon first might be more feasible.
 
Glucagon should be considered first then IV glucose second if glucagon does not work or should be considered first if glucagon is unlikely to work.

Why go for a more invasive procedure than required and as soon as you stick a drip into somebody they must be transported, so why not give them some glucagon and leave em at home?
 
I beleive Glucagon is also a little harder on the body and does not last as long. Especially in seniors.
 
MrBrown said:
Glucagon should be considered first then IV glucose second if glucagon does not work or should be considered first if glucagon is unlikely to work.

Why go for a more invasive procedure than required and as soon as you stick a drip into somebody they must be transported, so why not give them some glucagon and leave em at home?
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We don't have to transport people just because we gave them IV dextrose, they are allowed to refuse if they meet certain criteria.
 
rhan101277 said:
I hope you mean IV, if you give D50 IM then you are going to cause some major necrosis.

I could not obtain IV and I was not comfortable giving him oral glucose due to his LOC, so IM glucagon.
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I'm an EMT-B, can't give IM so thinking IV.
 
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