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Re: [IPm] news on medscape: subcutaneous glucagon use for mi



In clinical practice, I've not had any episodes of ketosis arise after use of
mini-dose glucagon and I and my partners have used this now over100 times.
Although I would not ever recommend that this dose be used in a case of severe
hypoglycemia (given any scientific proof of efficacy in severe hypoglycemia), a
parent who had previously used mini-dose glucagon inadvertently administered the
mini-dose during an episode of severe hypoglycemia and reported a prompt
recovery in the same time frame as would have been expected with the full dose.
An interesting anecdote.

Paul David L LtCol 60MDG/SGOMM wrote:

> Just remember, glucagon stimulates hepatic ketogenesis.  The study did not
> look at ketones in these kids. Granted sick kids having trouble with keeping
> sugars up aren't usually having significant ketone levels, but certainly
> there are kids who present with DKA with blood sugars not very elevated.  I
> suspect the lower doses of glucagon are not as potent in terms of
> stimulating ketone production and these kids will also likely be having
> their serum / urine ketone levels checked often anyway.
>
> Dave Paul, MD
> Travis AFB, CA
>
> -----Original Message-----
> From: Stephen W. Ponder MD, CDE [mailto:email @ redacted]
> Sent: Thursday, May 10, 2001 4:09 PM
> To: email @ redacted
> Subject: Re: [IPm] news on medscape: subcutaneous glucagon use for mi
>
> Michael:
>
> Mini-dose glucagon is very useful. I've been using it in practice since
> 1996-97. I was advised of it's usefullness by my colleagues in Texas who
> did the formal study. I've used it countless times and it works
> fantastically in the situations you describe. We've been using a
> "mega-dose" of glucagon for almost 40 years now, primarily to treat
> severe hypoglycmeia. Lower doses are useful to raise blood sugar levels
> in children who have milder hypoglycemia (not having a seizure or
> impairment in consicousness) and it often has the added benefit of
> improving the toddler's willingness to take in oral carbs. I  now use it
> as part of my routine management of these sorts of situations. It often
> may prevent a trip to the ER as well!
>
> Steve Ponder MD, CDE
>
> Michael wrote:
>
> > Thought this might be of interest
> >
> > www.medscape.com/reuters/prof/2001/05/05.10/20010509clin014.html
> >
> > Glucagon is usually given as an intramuscular injection in severe
> > hypoglycaemia. The study looked at using subcutaneous injections of
> > smaller doses of glucagon in children with gastroenteritis who can't
> > eat and children who are refusing carbohydrate. Apparently it worked
> > very well at maintaining blood sugars.
> >
> > I've seen a number of statistics on how long it takes information to
> > get from a study into clinical practise. The highest figure I've seen
> > so far is 17 years (!), but the average seems to be ten. And this
> > seems like it could be something very useful.
> >
> > Michael Robinton
> > Executive Director
> > email @ redacted
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