Mini-dose glucagon rescue for hypoglycemia in children with type I diabetes

OBJECTIVE - Children with type 1 diabetes are frequently difficult to manag e during times of gastroenteritis or poor oral intake of carbohydrates beca use of mild or impending hypoglycemia. The present study describes the effe ctive use of small doses of subcutaneous glucagon in these children. RESEARCH DESIGN AND METHODS - We analyzed 33 episodes of impending or mild hypoglycemia in 28 children (ages 6.6 +/- 0.7 years). All were healthy exce pt for type 1 diabetes and an episode of gastroenteritis. Using a standard U-100 insulin syringe, children ages less than or equal to2 years received two "units" (20 mug) of glucagon subcutaneously and those ages > 2 years re ceived one unit/year of age up to 15 units (150 mug). if the blood glucose did not increase within 30 min, the initial dosage was doubled and given at that time. We used patients' self-glucose monitoring devices, aqueous gluc agon, standard insulin syringes, and frequent phone contact with a physicia n and/or a diabetes nurse educator in this study. RESULTS - Blood glucose was 3.44 +/- 0.15 mmol/l before and 8.11 +/- 0.72 m mol/l 30 min after glucagon. In 14 children, relative hypoglucemia recurred , requiring retreatment (3.48 +/- 0.18 to 6.94 +/- 0.72 mmol/l). In four ch ildren, a third dose was required. The glucagon was well tolerated. In 28 o f the 33 episodes of impending hypoglycemia, the children remained at home and fully recovered. Five children were taken to their local hospital becau se of concerns of dehydration or fever, but none for hypoglycemia. CONCLUSIONS - Mini-dose glucagon rescue, using subcutaneous injections, is effective in managing children with type 1 diabetes during episodes of impe nding hypoglycemia due to gastroenteritis or poor oral intake of carbohydra te.