Hypoglycaemia: Intravenous glucose restored consciousness more quickly than intravenous glucagon

Clinical bottom line (level 1b)

  1. Intravenous glucose (50ml of 50% dextrose) achieved a return to consciousness in diabetic patients with hypoglycaemic coma more quickly than intravenous glucagon (4min median vs. 6.5min median)
  2. Both therapies produced headache as a side effect in about 50% of cases
Collier et al: Diabetes Care 1987; 10 (6): 712-715
Expires August 2003

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: accident and emergency department in Edinburgh, UK

49 patients (aged mean 40 years, ?% male) hypoglycaemic coma associated with known insulin-dependent diabetes mellitus (IDDM)

Excluded if
  • subsequent visits of previously entered patients
  • co-morbidity with Addison's disease


    • Control Group: (n = 24, 24 analysed): i/v glucose (50ml of 50%)
    Experimental Group: (n = 25, 25 analysed): i/v glucagon (1mg)

    100% followed for 30 minutes

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    Headache on returning to normal consciousness 2 hours 12
    (50%)    		 13
    (52%)    		 -4%
    (-80% to 40%)    		 -2%
    (-30% to 26%)    		 50
    (NNT = 4 to infinity;
    NNH = 3 to infinity)
    Vomiting on administration of therapy 5 minutes 9
    (37.5%)    		 8
    (32%)    		 15%
    (-84% to 61%)    		 5%
    (-21% to 32%)    		 18
    (NNT = 5 to infinity;
    NNH = 3 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    Time to normal consciousness (as assessed by independent observer) 4 min median
    ()     		6.5 min median
    ()     		2.5 min
    ( to )

    Comments

    1. Single-blinded as only comatose patients enrolled
    2. Uncertain clinical significance of the 2.5min median difference between return to consciousness
    3. Study too small to assess the potential problems of extravasation of 50% dextrose

    Citation

    1. Collier A, Steedman DJ, Patrick AW, et al: Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an accident and emergency department. Diabetes Care 1987; 10 (6): 712-715
    Contributor: Bob Phillips and Clare Wotton, August 1999
    Reviewer:

    Clinical Question.
    Patient hypoglycaemic
    Intervention or Exposure glucagon
    Comparison 50% dextrose
    Outcome time to consciousness, adverse effects