Oral glucose gel

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Oral glucose gel is an over-the-counter medication, consisting primarily of dextrose and water, along with small amounts of other compounds. It is frequently used by people with diabetes and those with hypoglycaemia to raise their blood glucose when it becomes dangerously low.

Contents

Hypoglycaemia occurs when blood sugar levels drop too low; it can cause a variety of symptoms including hunger, sweating, rapid heart rate, and shaking. If left untreated, hypoglycaemia can lead to a loss of consciousness. Onset of hypoglycaemia can be sudden, requiring glucose levels to be normalised by consuming carbohydrates. Diabetics are generally recommended to carry 15 grams of glucose with them at all times. [1]

Use

Oral glucose gel is used to raise dangerously low blood glucose concentration or blood glucose that has dropped too low for the person's adaptive compensatory mechanisms to cope with. The gel may be self-administered or given by an Emergency Medical Technician or paramedic responding to a hypoglycaemic emergency.

As glucose molecules will absorb directly through oral tissue, the gel is either swallowed directly or allowed to stay in the mouth momentarily to facilitate rapid absorption via various areas of the mouth cavity [2] and then swallowed to allow absorption into the blood via the small intestine.

Effectiveness

Although oral glucose gel is often recommended to diabetics, including by medical providers and organisations such as Diabetes UK, [3] its efficacy in treating hypoglycaemia has been questioned. A 1978 study demonstrated poor absorption through the oral mucosa, and concluded that such gels have therapeutic value only when swallowed by the patient. [4]

A study published in the journal Diabetes Care found administration of glucagon a superior treatment for hypoglycaemia compared to oral glucose gel, with those receiving glucagon injections experiencing a significantly greater increase in mean capillary glucose concentration. [5]

The American Red Cross Scientific Advisory Council recommend against the use of oral gels, in favour of more effective treatments such as glucagon injections or glucose tablets. [6]

A 2013 Cochrane Review concluded glucose gels were an effective treatment for neonatal hypoglycaemia; [7] a randomised, double-blind, placebo-controlled trial published by the same authors drew the same conclusion. [8] However, a systematic review in 2016 found faults with the initial Cochrane review, including the possibility of bias due to the small number of studies analysed and poor evidence many of these studies offered, calling for further randomised control trials to be undertaken. [9]

Products

Oral glucose gel usually is found in single-use tubes providing a dose of 15 grams of glucose, or resealable tubes with a total of 45 grams of glucose. It is often fruit-flavoured. Available brands include Glucogel in the United Kingdom, [10] and GlucoBurst and Insta-Glucose in the United States.

Related Research Articles

<span class="mw-page-title-main">Hypoglycemia</span> Health condition

Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. Hypoglycemia may result in headache, tiredness, clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness, nervousness, hunger, loss of consciousness, seizures, or death. Symptoms typically come on quickly.

<span class="mw-page-title-main">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

Drugs used in diabetes treat diabetes mellitus by altering the glucose level in the blood. With the exception of insulin, most GLP receptor agonists, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of anti-diabetic drugs, and their selection depends on the nature of diabetes, age, and situation of the person, as well as other factors.

<span class="mw-page-title-main">Blood sugar level</span> Concentration of glucose present in the blood (Glycaemia)

The blood sugar level, blood sugar concentration, blood glucose level, or glycemia, is the measure of glucose concentrated in the blood. The body tightly regulates blood glucose levels as a part of metabolic homeostasis.

<span class="mw-page-title-main">Gestational diabetes</span> Medical condition

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to mothers with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.

Hyperinsulinemic hypoglycemia describes the condition and effects of low blood glucose caused by excessive insulin. Hypoglycemia due to excess insulin is the most common type of serious hypoglycemia. It can be due to endogenous or injected insulin.

<span class="mw-page-title-main">Congenital hyperinsulinism</span> Medical condition

Congenital hyperinsulinism (HI or CHI) is a rare condition causing severe hypoglycemia in newborns due to the overproduction of insulin. There are various causes of HI, some of which are known to be the result of a genetic mutation. Sometimes HI occurs on its own (isolated) and more rarely associated with other medical conditions.

<span class="mw-page-title-main">Incretin</span> Group of gastrointestinal hormones

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood-glucose–dependent mechanism.

<span class="mw-page-title-main">Diabetic hypoglycemia</span> Medical condition

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an estimated 55,819 cases involved insulin, and severe hypoglycemia is likely the single most common event.

Enteroglucagon is a peptide hormone derived from preproglucagon. It is a gastrointestinal hormone, secreted from mucosal cells primarily of the colon and terminal ileum. It consists of 37 amino acids. Enteroglucagon is released when fats and glucose are present in the small intestine; which decrease the motility to allow sufficient time for these nutrients to be absorbed.

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Inhibitors of dipeptidyl peptidase 4 are a class of oral hypoglycemics that block the enzyme dipeptidyl peptidase-4 (DPP-4). They can be used to treat diabetes mellitus type 2.

<span class="mw-page-title-main">Glucagon rescue</span>

Glucagon rescue is the emergency injection of glucagon in case of severe diabetic hypoglycemia. It is needed during seizures and/or unconsciousness by an insulin user who is unable at that point to help themselves. Glucagon will facilitate the release of stored glucose back into the bloodstream, raising the blood glucose level.

<span class="mw-page-title-main">Blood sugar regulation</span> Hormones regulating blood sugar levels

Blood sugar regulation is the process by which the levels of blood sugar, the common name for glucose dissolved in blood plasma, are maintained by the body within a narrow range.

Chronic Somogyi rebound is a contested explanation of phenomena of elevated blood sugars experienced by diabetics in the morning. Also called the Somogyi effect and posthypoglycemic hyperglycemia, it is a rebounding high blood sugar that is a response to low blood sugar. When managing the blood glucose level with insulin injections, this effect is counter-intuitive to people who experience high blood sugar in the morning as a result of an overabundance of insulin at night.

Albiglutide is a glucagon-like peptide-1 agonist drug marketed by GlaxoSmithKline (GSK) for treatment of type 2 diabetes. As of 2017 it is unclear if it affects a person's risk of death. GSK has announced that it intends to withdraw the drug from the worldwide market by July 2018 for economic reasons.

Complications of diabetes mellitus include problems that develop rapidly (acute) or over time (chronic) and may affect many organ systems. The complications of diabetes can dramatically impair quality of life and cause long-lasting disability. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels. Some non-modifiable risk factors such as age at diabetes onset, type of diabetes, gender and genetics may influence risk. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise. Complications of diabetes are a strong risk factor for severe COVID-19 illness.

<span class="mw-page-title-main">Diabetes</span> Medical condition

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.

Neonatal hypoglycemia occurs when the neonate's blood glucose level is less than the newborn's body requirements for factors such as cellular energy and metabolism. There is inconsistency internationally for diagnostic thresholds. In the US, hypoglycemia is when the blood glucose level is below 30 mg/dL within the first 24 hours of life and below 45 mg/dL thereafter. In the UK, however, lower and more variable thresholds are used. The neonate's gestational age, birth weight, metabolic needs, and wellness state of the newborn has a substantial impact on the neonates blood glucose level. There are known risk factors that can be both maternal and neonatal. This is a treatable condition. Its treatment depends on the cause of the hypoglycemia. Though it is treatable, it can be fatal if gone undetected. Hypoglycemia is the most common metabolic problem in newborns.

Gliflozins are a class of drugs in the treatment of type 2 diabetes (T2D). They act by inhibiting sodium/glucose cotransporter 2 (SGLT-2), and are therefore also called SGLT-2 inhibitors. The efficacy of the drug is dependent on renal excretion and prevents glucose from going into blood circulation by promoting glucosuria. The mechanism of action is insulin independent.

References

  1. ↑ "How To Treat A Low Blood Glucose". Joslin Diabetes Center . Retrieved 20 November 2018.
  2. ↑ Kurosaki, Yuji; Yano, Koji; Kimura, Toshikiro (1998). "Perfusion Cells for Studying Regional Variation in Oral Mucosal Permeability in Humans. 2. A Specialized Transport Mechanism in D-Glucose Absorption Exists in Dorsum of Tongue". Journal of Pharmaceutical Sciences. 87 (5): 613–615. doi:10.1021/js9703028. ISSN   0022-3549. PMID   9572913.
  3. ↑ "Having a hypo". Diabetes UK . Retrieved 20 November 2018.
  4. ↑ Gunning RR, Garber AJ (1978). "Bioactivity of instant glucose. Failure of absorption through oral mucosa". JAMA. 240 (15): 1611–2. doi:10.1001/jama.1978.03290150057025. PMID   691147.
  5. ↑ Vermeulen, M. J.; Klompas, M.; Ray, J. G.; Mazza, C.; Morrison, L. J. (2003). "Subcutaneous Glucagon May Be Better Than Oral Glucose for Prehospital Treatment of Symptomatic Hypoglycemia". Diabetes Care. 26 (8): 2472–2473. doi: 10.2337/diacare.26.8.2472 . ISSN   0149-5992. PMID   12882885.
  6. ↑ http://www.instructorscorner.org/media/resources/SAC/Advisory%20Glucose%20for%20Diabetes%20Final%20for%20Posting%20%201_7_12.pdf [ bare URL PDF ]
  7. ↑ Weston, Philip J; Harris, Deborah; Battin, Malcolm; Brown, Julie; Hegarty, Jo; Harding, Jane E; Weston, Philip J (2014). "Oral dextrose gel for the treatment of hypoglycaemia in newborn infants". In Weston, Philip J (ed.). Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011027. S2CID   247520547.
  8. ↑ Harris, Deborah L; Weston, Philip J; Signal, Matthew; Chase, J Geoffrey; Harding, Jane E (2013). "Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial". The Lancet. 382 (9910): 2077–2083. doi:10.1016/S0140-6736(13)61645-1. hdl: 10092/8846 . ISSN   0140-6736. PMID   24075361. S2CID   14315927.
  9. ↑ Chandrasekharan P, Lakshminrusimha S (2017). "The effectiveness of oral dextrose gel for the treatment of neonatal hypoglycaemia remains unclear". Evid-Based Nurs. 20 (3): 80–81. doi:10.1136/eb-2016-102466. PMC   5567727 . PMID   28601799.
  10. ↑ "My Diabetes My Way". NHS Scotland . Retrieved 20 November 2018.
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