Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes.
OBJECTIVE
Children with type 1 diabetes are frequently difficult to manage during times of gastroenteritis or poor oral intake of carbohydrates because of mild or impending hypoglycemia. The present study describes the effective use of small doses of subcutaneous glucagon in these children.


METHODS
We analyzed 33 episodes of impending or mild hypoglycemia in 28 children (ages 6.6 +/- 0.7 years). All were healthy except for type 1 diabetes and an episode of gastroenteritis. Using a standard U-100 insulin syringe, children ages < or = 2 years received two "units" (20 microg) of glucagon subcutaneously and those ages >2 years received one unit/year of age up to 15 units (150 microg). If the blood glucose did not increase within 30 min, the initial dosage was doubled and given at that time. We used patients' self-glucose monitoring devices, aqueous glucagon, standard insulin syringes, and frequent phone contact with a physician and/or a diabetes nurse educator in this study.


RESULTS
Blood glucose was 3.44 +/- 0.15 mmol/l before and 8.11 +/- 0.72 mmol/l 30 min after glucagon. In 14 children, relative hypoglycemia recurred, requiring retreatment (3.48 +/- 0.18 to 6.94 +/- 0.72 mmol/l). In four children, a third dose was required. The glucagon was well tolerated In 28 of the 33 episodes of impending hypoglycemia, the children remained at home and fully recovered. Five children were taken to their local hospital because of concerns of dehydration or fever, but none for hypoglycemia.


CONCLUSIONS
Mini-dose glucagon rescue, using subcutaneous injections, is effective in managing children with type 1 diabetes during episodes of impending hypoglycemia due to gastroenteritis or poor oral intake of carbohydrate.
Haymond
M W
MW
Texas Children's Hospital Diabetes Care Center for Children and Adolescents, Department of Pediatrics, Baylor College of Medicine, Houston, USA. mhaymod@bcm.tmc.edu
Schreiner
B
B
D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D005759:Gastroenteritis / Q000150:complications* / Q000503:physiopathology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005934:Glucagon / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D007279:Injections, Subcutaneous; D007328:Insulin / Q000009:adverse effects*; D010290:Parents / Q000193:education
D001786:Blood Glucose; D005765:Gastrointestinal Agents; D007328:Insulin; D005934:Glucagon