Is Glucagon for unconscious hypoglycemia Pt. ?

FlamingFirefox

FlamingFirefox

Forum Probie
Messages
27
Reaction score
5
Points
3
So to the best of my knowledge glucagon converts glycogen stored in the liver into glucose when glucose levels are low in circulation. My question is.. the body can detect low BGL thus producing glucagon to get more glucose out into the circulation. So if someone goes unconcious does that mean the glucose and The glycogen that was stored was all used up? So IM glucagon can’t help this PT? Thanks in advance.
 
I feel like it is dependent on each patient but I have had unconscious hypoglycemic patients respond well to IM glucagon, but have also had ones not respond at all to IM glucagon, with them having depleted glycogen stores.
 
It is my understanding that the body doesn't release enough glucagon to return blood sugar levels to normal, so glycogen stores remain (patient dependent).
 
FlamingFirefox said:
So to the best of my knowledge glucagon converts glycogen stored in the liver into glucose when glucose levels are low in circulation. My question is.. the body can detect low BGL thus producing glucagon to get more glucose out into the circulation. So if someone goes unconcious does that mean the glucose and The glycogen that was stored was all used up? So IM glucagon can’t help this PT? Thanks in advance.
Click to expand...
in theory, it should happen this way, but the person is unconscious bc their BGL has dropped below an acceptable level. I also think it doesn't get released quickly. first line treatment is D5W or d10 mixed with NS (I think, someone, correct me on this, as I know it can be necrotic if it blows the vein so the delivery mechanism does change, and it's been a while for me), because it raises the BGL quickly, but you want a more lasting meal for better sugar maintenance. you can sometimes give glucagon IM, which causes the liver to release the glycogen stores into the body to improve the patient's mental status, provided they have any in there. but you still need to get more sugar into the person's body, which glycogen won't do.
 
EMS-wise, it's a question of what is accessible (IV or IM), and acuity of the patient. As I am currently an ED RN, glucagon is never used in my experience. If the pt is alert enough (A&O and can swallow), we use apple juice, obviously something you don't carry on the bus. We normally use an amp of D50 followed by IV infusion of D10 normally, sometimes D5W depending on the provider.
 
FlamingFirefox said:
So to the best of my knowledge glucagon converts glycogen stored in the liver into glucose when glucose levels are low in circulation. My question is.. the body can detect low BGL thus producing glucagon to get more glucose out into the circulation. So if someone goes unconcious does that mean the glucose and The glycogen that was stored was all used up? So IM glucagon can’t help this PT? Thanks in advance.
Click to expand...
You are correct on what the hormone glucagon does. That process is called gluconeogenesis. It involves the liver creating glucose from stored sources and then releasing it into the bloodstream.

The problem with that happening naturally it that it is a slow process. When exogenous (externally-administered) glucagon is given, serum levels are much higher than they are naturally and it speeds up the liver releasing glucose into the blood.

Clinically, glucagon is used mainly when an IV isn't readily available. If you have an IV, you give IV dextrose.
 
PA is adding intranasal glucagon (Baqsimi) to the BLS scope of practice as an optional protocol.

We have areas where a medic may be 40 minutes away and with a glucometer, an EMT can easily determine hypoglycemia and blast some glucagon up the snout.

One of the better protocol additions I’ve seen in a while.
 
NomadicMedic said:
PA is adding intranasal glucagon (Baqsimi) to the BLS scope of practice as an optional protocol.

We have areas where a medic may be 40 minutes away and with a glucometer, an EMT can easily determine hypoglycemia and blast some glucagon up the snout.

One of the better protocol additions I’ve seen in a while.
Click to expand...
Do you know what the cost of Baqsimi is? Glucagon is still quite pricey in its usual form.
Here all the EMTs can drill IOs and give D50 through that so we just go with that if they can’t get IV access *shrug.*
 
It costs a bit less than regular glucagon and has a much longer shelf life.
I’m not sure on the exact price, but was told it’s less.

No IO for our basics here. (and there’s no way you can tell me it’s a good idea).
 
NomadicMedic said:
It costs a bit less than regular glucagon and has a much longer shelf life.
I’m not sure on the exact price, but was told it’s less.

No IO for our basics here. (and there’s no way you can tell me it’s a good idea).
Click to expand...
Hmm maybe we will start doing that instead of glucagon. We're only carrying a single dose on the ambulances so it's not like we can even use it for other uses (BB/CCB OD).
 
Anymore I feel like we only carry glucagon because the state requires it.
 
NomadicMedic said:
PA is adding intranasal glucagon (Baqsimi) to the BLS scope of practice as an optional protocol.

We have areas where a medic may be 40 minutes away and with a glucometer, an EMT can easily determine hypoglycemia and blast some glucagon up the snout.

One of the better protocol additions I’ve seen in a while.
Click to expand...
While I am normally in favor of adding stuff to the BLS scope, especially when there is no downside, I would be wary of this. In my experience, Glucagon isn't a first line medication for diabetics prehospitally, nor is it a first line medication in the ER. In fact, I know some smart ER nurses that are very cautious about giving glucagon (and one was shocked that paramedics were able to give any hormones in the field). I mean, what if it doesn't work? As you know, there is a reason paramedics give dextrose before they reach for the glucagon
NomadicMedic said:
No IO for our basics here. (and there’s no way you can tell me it’s a good idea).
Click to expand...
Just to facilitate discussion, why not? they are (relatively) hard to mess up, if you are giving it on an unconcious diabetic they won't feel it (we drill all cardiac arrests as initial IV access. and it's preferably to an EJ). is it easier or harder to drill an unconscious person than to establish an IV? is the risk of infection greater? All the smarter people than me said there were few negative long term side effects to an IO.

btw, I'm not saying basics should be able to IO everyone, just trying to understand the thought process (esp in places like Co, where EMTs can start IVs).
 
Has anyone changed IO protocols to reflect ACLS's 2020 conclusion that IV access should be attempted first (p.185 of the provider manual)?
 
E tank said:
Try it on your next gall bladder attack...relaxes sphincter of Oddi and can relieve acute biliary pain...you're welcome...:)
Click to expand...
We use it as a first med on patients with a food bolus in their throat. Works about 20% of the time, not great numbers but sure beats calling in ENT :cool:
 
Capital said:
We use it as a first med on patients with a food bolus in their throat. Works about 20% of the time, not great numbers but sure beats calling in ENT :cool:
Click to expand...
If glucagon doesn't work, try neostigmine.
 
DrParasite said:
in theory, it should happen this way, but the person is unconscious bc their BGL has dropped below an acceptable level. I also think it doesn't get released quickly. first line treatment is D5W or d10 mixed with NS (I think, someone, correct me on this, as I know it can be necrotic if it blows the vein so the delivery mechanism does change, and it's been a while for me), because it raises the BGL quickly, but you want a more lasting meal for better sugar maintenance. you can sometimes give glucagon IM, which causes the liver to release the glycogen stores into the body to improve the patient's mental status, provided they have any in there. but you still need to get more sugar into the person's body, which glycogen won't do.
Click to expand...
It’s possible that people on Diabetic meds will have a huge dive downwards Fast with their BGL and their own glucagon won’t be able to keep up. compared to a person with no meds and no diabetes if a person with no diabetes just has a case of hypoglycemia due to just not eating, will be able to compensate just a thought.
 
You must log in or register to reply here.
Back
Top