Coma; Emergency therapy; Glucagon; Hypoglycaemia; Type 1 diabetes; Child; Blood Glucose; Hypoglycemic Agents; Insulin; Adolescent; Adult; Coma/chemically induced; Glucagon/adverse effects; Glucagon/therapeutic use; Humans; Hypoglycemic Agents/adverse effects; Diabetes Mellitus, Type 1/complications; Diabetes Mellitus, Type 1/drug therapy; Hypoglycemia/chemically induced; Diabetes Mellitus, Type 1; Hypoglycemia; Medicine (all)
Abstract :
[en] Patients with insulin-treated type 1 diabetes (T1D) are exposed to hypoglycaemia, which may be serious. Serious cognitive impairment (including coma and seizure) that requires the help of a third party is a medical emergency. Besides the intravenous injection of glucose by a health care provider, its treatment consists of the subcutaneous or intramuscular injection of glucagon which may be performed by a family member. However, such an injection is not easy and puts off some people, which retards the initiation of a potentially life-saving therapy. The intranasal administration of 3 mg glucagon has been shown as efficacious as the subcutaneous or intramuscular injection of 1 mg glucagon in controlled studies carried out in both adult and youth patients with T1D. Stimulation and real-life studies among caregivers, patients and acquaintances showed a preference for nasal glucagon because of its easy and quick use. The launch of nasal glucagon (Baqsimi®) offers new perspectives for the ambulatory emergency management of severe hypoglycaemia and hypoglycaemic coma with a special obvious advantage in children. [fr] La personne avec un diabète de type 1 (DT1) traité par insuline est exposée à un risque d’hypoglycémie, parfois grave. L'hypoglycémie sévère qui désigne tout trouble cognitif grave (y compris coma, convulsion) nécessitant l'intervention d'un tiers est une urgence médicale. Outre l’injection de glucose par voie intraveineuse, réservée à un personnel de santé, le traitement consiste en l’injection de glucagon par voie sous-cutanée ou intramusculaire qui peut être réalisée par un membre de l’entourage. Cependant, cette injection n’est pas aisée et rebute certaines personnes, ce qui retarde la mise en route d’un traitement potentiellement salvateur. L’administration nasale de glucagon 3 mg s’est avérée aussi performante que l’injection sous-cutanée ou intramusculaire de 1 mg dans des études contrôlées réalisées chez des patients DT1 adultes ou enfants/adolescents. Des études de simulation et de vraie vie réalisées auprès de soignants, de patients et de connaissances ont montré une préférence pour la forme nasale en raison de sa facilité et rapidité d’utilisation. La commercialisation du glucagon nasal (Baqsimi®) offre de nouvelles perspectives pour le traitement d’urgence ambulatoire de l'hypoglycémie sévère et du coma, avec un avantage particulièrement évident chez les enfants.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Philips, Jean-Christophe ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques
Radermecker, Régis ; Centre Hospitalier Universitaire de Liège - CHU > > Service de diabétologie, nutrition, maladies métaboliques
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