A comparison of glucagon and glucose in prehospital hypoglycaemia

Objective-To compare intramuscular glucagon with intravenous glucose in the prehospital management of hypoglycaemia in adults. Methods-In the first part of the trial all UK ambulance services were asked how their personnel treat prehospital episodes of hypoglycaemia. In the second part, two protocols for treating prehospital hypoglycaemia were studied. In phase 1, intramuscular glucagon 1 mg was used. In phase 2, intravenous glucose 25 g was used; if intravenous access was not possible, intramuscular glucagon was given. Results-33 out of 43 respondent ambulance services (76.7%) only use glucagon for prehospital hypoglycaemia; the remaining services use glucose and glucagon. In the second part of the study the median duration from diagnosis to full orientation (Glasgow coma score 15) was 28 minutes (95% confidence interval 18 to 49 minutes) in phase 1 and 11 minutes (95% confidence interval 8 to 19 minutes) in phase 2. This difference is statistically significant (P <0.005). On-scene times were not significantly different. Conclusions-Intravenous glucose is the treatment of choice in prehospital hypoglycaemia but glucagon should also be available for intramuscular use when intravenous access is not possible.