Epipen as an alternative to glucagon in the treatment of hypoglycemia in children with diabetes

OBJECTIVE - Fear of a severe hypoglycemic reaction is a major obstacle to a chieving near normal plasma glucose levels. Although parenteral glucagon is effective in treating these reactions. it is cumbersome to use, causes sev ere nausea, and is impractical in the school setting Epinephrine is availab le as a premixed injection (Epipen) that ma) be used by all care providers. Using Epipen to treat hypoglycemia may be an effective, sate, and easy-to- use alternative to glucagon. RESEARCH DESIGN AND METHODS - Ten children (age 11.7 +/- 24 years) with typ e 1 diabetes were studied on two occasions. After an overnight equilibratio n period, hypoglycemia was induced via an insulin pump (1 mU (.) kg(-1 .) m in(-1). At a blood glucose level of 2.8 mmol/l, either glucagon (1 mg) or e pinephrine (0.3 mg), in random order, was administered intramuscularly and responses were monitored. RESULTS - Plasma free insulin concentrations were similar in both studies. Plasma glucose levels increased by 1.7 +/- 0.2 mmol/l (mean +/- SEM) in 10 min and by 2.6 +/- 0.2 mmol/l in 15 min with administration of glucagon and were not consistently increased with administration of epinephrine (P < 0. 01). Peak glucagon concentrations after administration of glucagon were > 6 0-fold higher than basal conc ent rations. After administration elf epineph rine. peak epinephrine levels were 20-fold higher than basal concentrations . CONCLUSIONS - Epinephrine does not seem Lo be an adequate substitute for gl ucagon in the treatment of severe hypoglycemia. The effectiveness of glucag on in reversing hypoglycemia and its side effects of nausea and vomiting ar e likely related to the markedly supraphysiologic plasma levels achieved wi th the standard intramuscular dose.