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IV Glucose is better than glucagon for hypoglycaemia

Three Part Question

In [insulin-dependent diabetic adults with accidental hypoglycaemia] does [intravenous glucose or intramuscular glucagon] provide [faster, more reliable restoration of normoglycaemia]?

Clinical Scenario

An insulin dependent diabetic adult is brought into the Emergency Department uncooperative and acutely confused. A blood glucose stick test confirms hypoglycaemia. You wonder whether parenteral glucose or glucagon is the drug of first choice.

Search Strategy

Medline 1966-03/00 using the OVID interface.
[({exp glucose OR OR} AND { OR exp injections, intravenous OR}) AND {exp glucagon OR} AND {exp hypoglycemia OR OR}] LIMIT to human AND english.

Search Outcome

166 papers found of which 162 irrelevant or of insufficient quality for inclusion. The four remaining papers are shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Collier A et al,
52 consecutive insulin dependent diabetic patients with hypoglycaemic coma. IV glucagon 1mg vs IV glucose 25gControlled clinical trialRecovery time to 6.5 min vs 4 minNot randomised. Not blinded.
Patrick AW et al,
29 consecutive insulin dependent diabetic patients with hypoglycaemic coma. IM glucagon 1mg vs IV glucose 25gPRCTFailures2 glucagon failuresNot blinded. Small numbers.
Recovery time to 9 min vs 3 min
Hvidberg A et al,
10 healthy non-diabetic subjects with experimental insulin induced hypoglycaemia. IM glucagon 1mg vs IV glucose 25gControlled experimentTime to normoglycaemiaNo significant differenceNon-diabetic subjects
Howell MA and Guly HR,
28 insulin dependent diabetic patients with hypoglycaemic coma in the prehospital environment. IM glucagon 1mg vs IV glucose 25gControlled clinical trialTime to Glasgow Coma Scale score of 15Significantly longer after glucagonBlock randomised. Not blinded. Small numbers.
Carstens S et al,
14 IDDM patients sequentially seen by a mobile ICU presenting with blood sugar< 3mmolRandomised controlled trial of IV dextrose 50mls 50% versus IM glucagon 1mgTime from treatment initiation to a full GCS 15 recoveryRecovery time for IV glucose mean 2.5 mins and for IM glucagon13.1 minsOnly 14 of 64 episodes actually attended were randomised. Not effectively blinded


Although no high quality evidence exists in this area it is clear that IV glucose works faster than IM glucagon once the treatment has been given. The time to establish access has not, however, been accounted for. Glucagon "failures" have been reported.

Clinical Bottom Line

IV glucose is the most reliable treatment for accidental hypoglycaemia. Once venous access is established it is also has the fastest effect.


  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;10:712-5.
  2. Patrick AW, Collier A, Hepburn DA et al. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an Accident and Emergency department. Arch Emerg Med 1990;7:73-7.
  3. Hvidberg A, Jorgensen S, Hilsted J. The effect of genetically engineered glucagon on glucose recovery after hypoglycaemia in man Br J Clin Pharmacol 1992;34:547-50.
  4. Howell MA, Guly HR. A comparison of glucagon and glucose in prehospital hypoglycaemia J Accid Emerg Med 1997;14:30-2.
  5. Carstens S et al, TBC