When To Use Glucagon IN

[emtannie]

It has been research and in use overseas.

www.intranasal.net

I went to that site, and wandered a bit - there is some good information there.

FOr those who don't want to spend the time, here is a clip I found:

"Literature overview and discussion

A moderate amount of literature exists demonstrating that intranasal glucagon is effective in treating hypoglycemia. Most of this literature suggests that nasal glucagon is optimally absorbed if mixed with a surfactant additive (such as sodium glycocholate rather than the sterile water diluent that comes with the package) to enhance absorption. The literature is also fairly clear in showing that intramuscular or subcutaneous glucagon leads to more rapid rises in blood glucose with longer effect.[3, 4] Pontiroli and colleagues have published the majority of data on this topic.[4-7] Other authors have also confirmed the effectiveness of IN glucagon when mixed with absorptive enhancers."

(http://www.intranasal.net/Glucagon/default.htm#Literature_overview_and_discussion)

I can see where IN would have advantages, especially in combative patients, or patients with very poor vascular access.

I'm not convinced it should be "the standard" for glucagon administration, as the research shows that it is not as rapid as IM injection, and the goal is to improve glucose levels as fast as possible.

[NYCEMS9115]

Its very interesting. I hope to see this in NYS...

[DwayneEMTP]

Are people using Glucagon regularly?

Part of the reason that I didn't use it on the case from the other thread is that I've never used it and was afraid that my inexperience with it might cloud my stroke exam if in fact I'd had faith it would have worked in the time frame I wanted.

Other than that, I don't think I've ever even considered it before, tell the truth.

Does anyone have significant experience with it? Why?

Dwayne

[tcripp]

Does anyone have significant experience with it? Why?

Dwayne

Only time I have used it was for esophageal choking. And, it did help to some degree.

[chbare]

Same here. Several times for oesophageal spasm.

Take care,

chbare.

[mobey]

Yes! I use it often.

It is our 1st line in a combative hyopglycemic, or one we cannot get a line on.

I have never had it fail, although it does take at least 5min to start working.

[FireMedic65]

If I remember correctly, the IN glucagon is the same stuff as the IM. You just put the dose in the syringe and put on the aerator instead of a needle.

In my experience I used glucagon IN a few times. I found it worked just the same as with IM. So, if you can't get the IV, go for the IN if you have it.

and yes, google is your friend, but this is a discussion board where you, well discuss things. Having info on a med and how you use it is one thing, but actually talking about it with other providers is something google can't do.... yet.

Edited April 11, 2011 by FireMedic65

[DwayneEMTP]

Yes! I use it often.

It is our 1st line in a combative hyopglycemic, or one we cannot get a line on.

I have never had it fail, although it does take at least 5min to start working.

See, this is kind of what I was asking, though I had forgotten it's usefulness in smooth muscle spasm and am grateful for the reminder, how often does this happen? I've run on scads of altered hypoglycemics but have never had a time when I couldn't get access. Even on a 6 m/o dehydrated babe. (yeah, had a 6 month old hypoglycemic...How do you think that happened?)

Just pulling from my head here, but also, doesn't Glucagon make the in hospital management of IDDM patients much more complex by burning their entire store of glycogen? No idea if that is true, or where I may have come to believe it..but it's the reason I've always considered Glucagon to be the ugly, illegitimate stepchild of Glucose. I've always questioned EVER using Glucagon in a system that allows I/Os. Am I completely off in the ditch?

Dwayne

Edited to add 'never' in the first paragraph.

Edited April 11, 2011 by DwayneEMTP

[tcripp]

Just pulling from my head here, but also, doesn't Glucagon make the in hospital management of IDDM patients much more complex by burning their entire store of glycogen? No idea if that is true, or where I may have come to believe it..but it's the reason I've always considered Glucagon to be the ugly, illegitimate stepchild of Glucose. I've always questioned EVER using Glucagon in a system that allows I/Os. Am I completely off in the ditch?

For our service, we don't have glucagon at all. Aside from price, the fact that we probably would have used it maybe once in the past year AND the fact we are about 20 minutes from a local facility...it's not effective if your patient has already used up their glycogen stores which is what would happen in your patients with insulin pumps that have gone screwy. We have IOs, but (as I've mentioned before) is not to be used for D50 unless we truly believe it is life or death and with that we must call for orders. (It's one of the few things that are a clear black and white in our guidelines.)

[chbare]

I've also used it a few times for beta blocker overdose.

Take care,

chbare.

See, this is kind of what I was asking, though I had forgotten it's usefulness in smooth muscle spasm and am grateful for the reminder, how often does this happen? I've run on scads of altered hypoglycemics but have never had a time when I couldn't get access. Even on a 6 m/o dehydrated babe. (yeah, had a 6 month old hypoglycemic...How do you think that happened?)

Just pulling from my head here, but also, doesn't Glucagon make the in hospital management of IDDM patients much more complex by burning their entire store of glycogen? No idea if that is true, or where I may have come to believe it..but it's the reason I've always considered Glucagon to be the ugly, illegitimate stepchild of Glucose. I've always questioned EVER using Glucagon in a system that allows I/Os. Am I completely off in the ditch?

Dwayne

Edited to add 'never' in the first paragraph.

I think you would strongly consider not using glucagon in chronic starvation, chronic hypoglycaemia and adrenal insufficiency because of limited glycogen stores; however, I'm not aware of glucagon significantly altering the hospital course of the acutely hypoglycaemic patient. Also, zebras such as pheochromocytoma and insulinoma should be considered near absolute contraindications IMHO.

Take care,

chbare.