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QUESTION 1: Can mini-glucagon be used to manage hypoglycaemia as an outpatient?
  1. Elspeth C Ferguson
  1. Correspondence to Dr Elspeth Clare Ferguson, Department of Paediatrics, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, S10 2TH. UK; elspethferguson{at}nhs.net

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Question

In a 5-year-old child with type 1 diabetes and gastroenteritis, can mini-glucagon be used to prevent or treat hypoglycaemia?

Scenario

The mother of a 5-year-old with type 1 diabetes calls her paediatrician for advice. Her daughter has gastroenteritis and is refusing to drink anything except water. She is struggling to keep her sugar level above 4 mmol/L. The mother would like to avoid her daughter being admitted to hospital. You have heard about using low doses of glucagon (mini-glucagon) to maintain normoglycaemia and wonder if there is any evidence that glucagon is a safe and effective treatment in this situation.

Structured clinical question

In a child with type 1 diabetes and gastroenteritis (patient), is mini-glucagon (intervention) safe and effective in preventing or treating hypoglycaemia (outcome)?

Search strategy

A search of the Cochrane database did not yield any relevant articles.

Subsequently, the primary database sources of EMBASE (1996 to January 2016) and MEDLINE via the Ovid interface (1996 to January 2016) were searched using the following search terms: Type One Diabetes AND Glucagon AND Hypoglycaemia and the searches were limited to children. This search identified 78 papers, from which three relevant original studies were identified.

Reviewing the references of the articles identified one further relevant article.1 The relevant articles are summarised in table 1.

View this table:
Table 1

Summary of studies on the efficacy of mini-glucagon in managing hypoglycaemia

Commentary

Hypoglycaemia is a common complication in children with type 1 diabetes. Severe episodes are defined in children, where hypoglycaemia is associated with a seizure or coma and requires parental therapy.5 Tight glycaemic control is necessary to reduce the risk of long-term complications but historically has carried an increased risk of hypoglycaemia.6 More recent evidence suggests that the risk of severe hypoglycaemia in association with tighter diabetes control is falling,7 yet it remains one of the complications most feared …

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